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General NPI Number Information
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NPI Number | 1881139384
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Entity Type | Organization
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Legal Business Name | MONTANA PEDIATRICS
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 2320 57TH ST
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City | MISSOULA
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State | MT
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Zip | 59803-3102
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Country | US
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Telephone | 406-272-4631
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7249
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City | MISSOULA
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State | MT
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Zip | 59807-7249
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Country | US
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Telephone | 406-303-1078
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHELSEA BODNAR
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Credential | MD
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Telephone | 406-272-4631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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