Provider Demographics
NPI:1104693571
Name:MAGE MEDICINE, P.L.L.C.
Entity type:Organization
Organization Name:MAGE MEDICINE, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-212-4523
Mailing Address - Street 1:PO BOX 1735
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-1735
Mailing Address - Country:US
Mailing Address - Phone:406-212-4523
Mailing Address - Fax:402-337-8898
Practice Address - Street 1:5938 US HIGHWAY 93 S
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-8415
Practice Address - Country:US
Practice Address - Phone:406-863-9300
Practice Address - Fax:402-337-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty