Provider Demographics
NPI:1194771881
Name:WESTERN MONTANA ORTHOTICS & PROSTHETICS, P.C.
Entity type:Organization
Organization Name:WESTERN MONTANA ORTHOTICS & PROSTHETICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-549-9667
Mailing Address - Street 1:1300 S RESERVE ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4704
Mailing Address - Country:US
Mailing Address - Phone:406-549-9667
Mailing Address - Fax:406-721-9667
Practice Address - Street 1:1300 S RESERVE ST
Practice Address - Street 2:SUITE G
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4704
Practice Address - Country:US
Practice Address - Phone:406-549-9667
Practice Address - Fax:406-721-9667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5690600001Medicare NSC