Provider Demographics
NPI:1043986672
Name:MONTANA MEDICAL SPECIALISTS PC
Entity type:Organization
Organization Name:MONTANA MEDICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:HIRENKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ITALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-557-8950
Mailing Address - Street 1:133 ROLLINS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 WEST MENDENHALL STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:800-557-8950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center