NPIMap

Organization Active NPI

Montana Endoscopy Center, PLLC

  • Ambulatory Surgical Clinic/Center
  • Missoula, MT
National Provider Identifier
1154945921
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
MONTANA ENDOSCOPY CENTER, PLLC
Practice address
1930 W Broadway
Ste B
Missoula, MT 59808
Phone
(406) 541-6836
NPI assigned
Jun 8, 2020
Last updated
Aug 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

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

Authorized official

Name
Robert McCarville
Title
Administrator
Phone
(417) 889-2040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1930 W Broadway
Ste B
Missoula, MT 59808

Mailing address

2808 S Ingram Mill Rd BLDG B
Springfield, MO 65804-4017
Phone (417) 889-2040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210512002800 MT Part B Supplier - Ambulatory Surgical Center 9436568979 Practice locations: Missoula, MT

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Montana Endoscopy CenterCCN 27C0001030
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
27D2227083Montana Endoscopy Center PLLC1930 Broadway Suite B, Missoula, MT 59808Certificate of waiverJun 7, 2027

National Provider Directory

National Provider Directory

Locations

1930 W Broadway St
Ste B
Missoula, MT 59808
Phone (406) 541-6836

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1154945921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2808 S INGRAM MILL RD BLDG B",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044017",
            "telephone_number": "417-889-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 W BROADWAY",
            "address_2": "STE B",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59808",
            "telephone_number": "406-541-6836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTANA ENDOSCOPY CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-08",
        "last_updated": "2021-08-18",
        "certification_date": "2021-07-28",
        "status": "A",
        "authorized_official_last_name": "MCCARVILLE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "417-889-2040"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.