=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568236644
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEDS HAPPY HEARTS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2023
-----------------------------------------------------
Last Update Date | 11/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 960 S 24TH ST W STE H
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-6450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-272-2376
-----------------------------------------------------
Fax | 406-645-7995
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5423 FIELD STONE AVE
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59106-1245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-272-2376
-----------------------------------------------------
Fax | 406-645-7995
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. NANCY HUA
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 406-272-2376
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0202X
-----------------------------------------------------
Taxonomy Name | Pediatric Cardiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------