Provider Demographics
NPI:1285092510
Name:SYDNEY D SEYFERT
Entity type:Organization
Organization Name:SYDNEY D SEYFERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:DIANN
Authorized Official - Last Name:SEYFERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-540-3556
Mailing Address - Street 1:821 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3833
Mailing Address - Country:US
Mailing Address - Phone:406-540-3556
Mailing Address - Fax:406-929-1049
Practice Address - Street 1:821 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3833
Practice Address - Country:US
Practice Address - Phone:406-540-3556
Practice Address - Fax:406-929-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT100915OtherSTATE ARNP LICENSE