Provider Demographics
NPI:1427469725
Name:BELLAMAH VEIN & SURGERY, PLLC
Entity type:Organization
Organization Name:BELLAMAH VEIN & SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BELLAMAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-509-1706
Mailing Address - Street 1:2975 STOCKYARD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1557
Mailing Address - Country:US
Mailing Address - Phone:513-509-1706
Mailing Address - Fax:
Practice Address - Street 1:2975 STOCKYARD RD
Practice Address - Street 2:SUITE 200 & 201
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1557
Practice Address - Country:US
Practice Address - Phone:513-509-1706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT9851OtherMT LICENSE