MEDICARE: MONTANA PLASTIC SURGERY CENTER

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	207Y00000X	Otolaryngology Physician	7778	MT
2	208200000X	Plastic Surgery Physician	7778	MT

General Provider Information

NPI Number	:	1659577898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTANA PLASTIC SURGERY CENTER

Provider Business Mailing Address
First Line	:	1600 9TH ST S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-4510
Country	:	US
Telephone Number	:	406-727-6363
Fax Number	:	406-727-6372

Provider Business Practice Location Address
First Line	:	1600 9TH ST S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-4510
Country	:	US
Telephone Number	:	406-727-6363
Fax Number	:	406-727-6372

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTONIO SANTIN
Credential	:	MD
Telephone Number	:	406-727-6363

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	02/22/2008

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