MEDICARE: MONTANA HEART CENTER CARDIOLOGY, 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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1922056621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTANA HEART CENTER CARDIOLOGY, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 4865
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59806-4865
Country	:	US
Telephone Number	:	406-541-7139
Fax Number	:	406-541-7143

Provider Business Practice Location Address
First Line	:	2827 FORT MISSOULA RD
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-7408
Country	:	US
Telephone Number	:	406-541-7139
Fax Number	:	406-541-7143

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. BRENDA HUSTON
Credential	:
Telephone Number	:	406-541-7139

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	03/17/2008

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