Montana Heart Angio Lab LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

71253 Issued in MT

Legal business name

MONTANA HEART ANGIO LAB LLC

Practice address

2827 Fort Missoula Rd
Missoula, MT 59804-7408

Phone

(406) 327-4614

Fax

(406) 327-4679

NPI assigned

Mar 6, 2007

Organization subpart

No

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

Authorized official

Name

John Dague

Title

Director

Phone

(406) 327-4131

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619007101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2827 FORT MISSOULA RD",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598047408",
            "telephone_number": "406-327-4614",
            "fax_number": "406-327-4679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2827 FORT MISSOULA RD",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598047408",
            "telephone_number": "406-327-4614",
            "fax_number": "406-327-4679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTANA HEART ANGIO LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAGUE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "406-327-4131"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MT",
            "license": "71253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Missoula, MT
• Clinical Medical Laboratory in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.