Organization
TOBACCO ROOT ANESTHESIOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK E VANDOLAH CRNA,MAE (PRESIDENT)
(406) 285-6588
Entity
Organization
Contact information
Practice address
7 VANDOLAH RD, THREE FORKS, MT 59752-8673
(406) 285-6588
(406) 285-9012
Mailing address
PO BOX 1330, THREE FORKS, MT 59752-1330
(406) 285-6588
(406) 285-9012
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN14372
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4308525
—
MT
Enumeration date
07/22/2006
Last updated
02/12/2014
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