Provider Demographics
NPI:1063422590
Name:MONTANA AUDIOLOGY AND BALANCE LLC
Entity type:Organization
Organization Name:MONTANA AUDIOLOGY AND BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-727-3115
Mailing Address - Street 1:1102 9TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4402
Mailing Address - Country:US
Mailing Address - Phone:406-727-3115
Mailing Address - Fax:406-727-4484
Practice Address - Street 1:1102 9TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4402
Practice Address - Country:US
Practice Address - Phone:406-727-3115
Practice Address - Fax:406-727-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000085577Medicare PIN