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General NPI Number Information
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NPI Number | 1821327008
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Entity Type | Organization
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Legal Business Name | MARK IBSEN INC
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 39 NEILL AVE
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City | HELENA
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State | MT
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Zip | 59601-3330
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Country | US
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Telephone | 406-513-1052
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Fax | 406-513-1054
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Provider Business Mailing Address
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Address Line | 39 NEILL AVE
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City | HELENA
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State | MT
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Zip | 59601-3330
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Country | US
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Telephone | 406-513-1052
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Fax | 406-513-1054
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK S IBSEN
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Credential | M.D.
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Telephone | 406-513-1052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7378
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 7378
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License Number State | MT
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