Kismet Col, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

9401 Issued in MT

Legal business name

KISMET COL, LLC

Doing business as

Beartooth Manor

Practice address

350 West Pike
Columbus, MT 59019

Phone

(406) 322-5342

NPI assigned

Jul 13, 2005

Last updated

Mar 19, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Moore

Title

Cfo

Phone

(605) 642-7736

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Beartooth Manor Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552953600000",
    "number": "1093713075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 WEST PIKE",
            "city": "COLUMBUS",
            "state": "MT",
            "postal_code": "590190789",
            "telephone_number": "406-322-5342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 WEST PIKE",
            "city": "COLUMBUS",
            "state": "MT",
            "postal_code": "59019",
            "telephone_number": "406-322-5342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KISMET COL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2019-03-19",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "605-642-7736"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MT",
            "license": "9401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053-3885",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beartooth Manor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beartooth Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marion Grummett, LCPC
• Susan E Ivankovich, PA-C
• Melissa J Jenkins, P.T.
• David Kane, MD
• Kent T Brown OD, PC
• Richard K. Klee, MD
• Michelle Cherie Kline, FNP-C
• Nicole Rae Legere, FNP
• Brian F Luepke, M.D.
• Valerie Maeker, OT

• Skilled Nursing Facility in Columbus, MT
• Providers in Columbus, MT by specialty
• Skilled Nursing Facility in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.