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General NPI Number Information
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NPI Number | 1528413093
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN VEIN CLINIC GREAT FALLS INC
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 1400 29TH ST S STE 201
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City | GREAT FALLS
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State | MT
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Zip | 59405-5316
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Country | US
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Telephone | 406-727-8346
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 29TH ST S STE 201
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City | GREAT FALLS
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State | MT
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Zip | 59405-5316
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Country | US
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Telephone | 406-727-8346
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES L JOHNSON II
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Credential | MD
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Telephone | 406-252-8346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 10772
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License Number State | MT
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