Organization
STATE OF MONTANA
Active
Parent organization
STATE OF MONTANA
Other names
Children's Special Health Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF MONTANA
Authorized official
MICHELE S O'DONNELL (BILLING AGENT)
(406) 444-3529
Entity
Organization
Contact information
Practice address
1400 BROADWAY RM A116, HELENA, MT 59620
(406) 444-3529
(406) 444-2750
Mailing address
PO BOX 202951, HELENA, MT 59620-2951
(406) 444-3529
(406) 444-2750
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0260000
—
MT
01
—
92046
BLUE CROSS BLUE SHIELD OF MONTANA
MT
01
—
92056
BLUE CROSS BLUE SHELD OF MONTANA
MT
01
—
99248
BLUE CROSS BLUE SHIELD OF MONTANA
MT
Enumeration date
04/10/2007
Last updated
01/25/2011
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