Provider Demographics
NPI:1194915744
Name:GLENN MCLAUGHLIN MD PC
Entity type:Organization
Organization Name:GLENN MCLAUGHLIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-465-0787
Mailing Address - Street 1:401 S ALABAMA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2315
Mailing Address - Country:US
Mailing Address - Phone:406-465-0787
Mailing Address - Fax:406-723-8063
Practice Address - Street 1:401 S ALABAMA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2315
Practice Address - Country:US
Practice Address - Phone:406-465-0787
Practice Address - Fax:406-723-8063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6220261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTDG6340OtherRAILROAD MEDICARE
MT0118274Medicaid
D08022Medicare UPIN
MTDG6340OtherRAILROAD MEDICARE