NPIMap

Organization Active NPI

Five Valleys Urology

  • Urology Physician
  • Missoula, MT
National Provider Identifier
1720067705
Registry record updated Apr 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
FIVE VALLEYS UROLOGY
Practice address
2875 Tina
Suite 101
Missoula, MT 59808-1308
Phone
(406) 728-3366
Fax
(406) 329-2896
NPI assigned
Jan 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2011

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

Authorized official

Name
Mr. John Terry O'Connor
Title
Practice Administrator
Phone
(406) 728-3366

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

2875 Tina
Suite 101
Missoula, MT 59808-1308

Mailing address

2875 Tina Ave
Suite 101
Missoula, MT 59808
Phone (406) 728-3366

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031124000663 MT Part B Supplier - Clinic/Group Practice 3870497571 Receives reassigned benefits from 13 practitioners
Practice locations: Missoula, MT
O20100930032628 MT DME Supplier - Physician - Urology 3870497571 Practice locations: Missoula, MT

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
27D0707089Five Valleys Urology2875 Tina Avenue Suite 101, Missoula, MT 59808ComplianceSep 13, 2027

National Provider Directory

National Provider Directory

Locations

601 W Spruce St
Ste G
Missoula, MT 59802
Phone (406) 728-3366

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303344000000",
    "number": "1720067705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2875 TINA AVE",
            "address_2": "SUITE 101",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59808",
            "telephone_number": "406-728-3366",
            "fax_number": "406-329-2896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 TINA",
            "address_2": "SUITE 101",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081308",
            "telephone_number": "406-728-3366",
            "fax_number": "406-329-2896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE VALLEYS UROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-10",
        "last_updated": "2011-04-21",
        "status": "A",
        "authorized_official_last_name": "O'CONNOR",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "TERRY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "406-728-3366",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "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 Apr 21, 2011; 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.