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General NPI Number Information
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NPI Number | 1669652087
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Entity Type | Organization
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Legal Business Name | RIVER GATES NEPHROLOGY, PC
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 2525 E BROADWAY ST STE 202A
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City | HELENA
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State | MT
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Zip | 59601-8049
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Country | US
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Telephone | 406-457-4280
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Fax | 406-457-4278
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Provider Business Mailing Address
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Address Line | 2525 E BROADWAY ST STE 202A
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City | HELENA
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State | MT
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Zip | 59601-8049
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Country | US
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Telephone | 406-457-4280
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Fax | 406-457-4278
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Authorized Official
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Title or Position | OWNER
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Name | MS. GWENDOLYN A PINCOMB
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Credential | MD
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Telephone | 406-457-4280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 10181
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License Number State | MT
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