Organization
MISSOULA SLEEP MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICK B WALL (MEMBER)
(406) 829-8053
Entity
Organization
Contact information
Practice address
910 BROOKS ST, SUITE 201, MISSOULA, MT 59801-5783
(406) 829-8053
(406) 541-8062
Mailing address
910 BROOKS ST, SUITE 201, MISSOULA, MT 59801-5783
(406) 829-8053
(406) 541-8062
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C108330
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000094581
BLUE CROSS/BLUE SHIELD
MT
05
—
0034408
—
MT
01
—
P00431402
RR MEDICARE
MT
Enumeration date
05/08/2006
Last updated
01/12/2010
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