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General NPI Number Information
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NPI Number | 1982354908
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Entity Type | Organization
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Legal Business Name | MOUNTAIN KIDS PEDIATRICS
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 2825 FORT MISSOULA RD STE 201
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City | MISSOULA
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State | MT
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Zip | 59804-7403
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Country | US
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Telephone | 406-721-5566
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Fax |
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Provider Business Mailing Address
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Address Line | 2825 FORT MISSOULA RD STE 201
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City | MISSOULA
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State | MT
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Zip | 59804-7403
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Country | US
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Telephone | 406-721-5566
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM HASTINGS
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Credential | DO
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Telephone | 406-721-5566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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