MEDICARE: BELLAMAH VEIN & SURGERY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9851	OTHER	MT	MT LICENSE

General Provider Information

NPI Number	:	1427469725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLAMAH VEIN & SURGERY, PLLC

Provider Business Mailing Address
First Line	:	2975 STOCKYARD RD
Second Line	:	SUITE 200
City	:	MISSOULA
State	:	MT
Zip	:	59808-1557
Country	:	US
Telephone Number	:	513-509-1706
Fax Number	:

Provider Business Practice Location Address
First Line	:	2975 STOCKYARD RD
Second Line	:	SUITE 200 & 201
City	:	MISSOULA
State	:	MT
Zip	:	59808-1557
Country	:	US
Telephone Number	:	513-509-1706
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID HOWARD BELLAMAH
Credential	:	M.D
Telephone Number	:	513-509-1706

Provider Enumeration Date	:	05/08/2014
Last Update Date	:	01/18/2024

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