=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740446632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. JAMES HEALTHCARE ORTHOPEDIC BILLING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2008
-----------------------------------------------------
Last Update Date | 07/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 435 S CRYSTAL ST STE 400
-----------------------------------------------------
City | BUTTE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59701-1506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-496-3400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 S CLARK ST
-----------------------------------------------------
City | BUTTE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59701-2328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN CONTRACTING
-----------------------------------------------------
Name | STEPHANIE FANTINI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-723-2436
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------