Provider Demographics
NPI:1447491287
Name:CENTRAL MONTANA HEARING & AUDIOLOGY, P.C.
Entity type:Organization
Organization Name:CENTRAL MONTANA HEARING & AUDIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY, PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:406-538-5072
Mailing Address - Street 1:625 NE MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 NE MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2084
Practice Address - Country:US
Practice Address - Phone:406-538-5072
Practice Address - Fax:406-538-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
MTAU1068261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty