MEDICARE: SHADRACH ROUNDY BARNEY L.D.

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	122400000X	Denturist	28	ND

General Provider Information

NPI Number	:	1689947269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHADRACH ROUNDY BARNEY L.D.

Provider Business Mailing Address
First Line	:	218 TERRACE RD
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-7432
Country	:	US
Telephone Number	:	406-885-0184
Fax Number	:

Provider Business Practice Location Address
First Line	:	734 9TH ST W STE 4
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-3858
Country	:	US
Telephone Number	:	406-892-0700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2012
Last Update Date	:	12/19/2024

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