Provider Demographics
NPI:1154032472
Name:CHRONIC DISEASE MANAGEMENT, LLC
Entity type:Organization
Organization Name:CHRONIC DISEASE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:KISHBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:406-224-2244
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:MT
Mailing Address - Zip Code:59632-0044
Mailing Address - Country:US
Mailing Address - Phone:406-224-2244
Mailing Address - Fax:
Practice Address - Street 1:7 MICROWAVE HILL RD STE C
Practice Address - Street 2:
Practice Address - City:CLANCY
Practice Address - State:MT
Practice Address - Zip Code:59634-8001
Practice Address - Country:US
Practice Address - Phone:406-946-2983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service