Active NPI
CMC Rehab Dept Neuropsych Evaluations
- Psychologist
- Missoula, MT
National Provider Identifier
1720216005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 226
- Legal business name
- CMC REHAB DEPT NEUROPSYCH EVALUATIONS
- Practice address
- 2827 Fort Missoula Rd
Missoula, MT 59804-7408 - Phone
- (406) 728-4100
- Fax
- (406) 327-4545
- NPI assigned
- Jun 25, 2009
- Organization subpart
- Yes
- Parent organization
- COMMUNITY MEDICAL CENTER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stephane G Carlson
- Title
- Ceo
- Phone
- (406) 728-4100
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 226 | MT | Primary |
Addresses
Primary practice location
2827 Fort Missoula Rd
Missoula, MT 59804-7408
Mailing address
2827 Fort Missoula Rd
Missoula, MT 59804-7408
Phone (406) 728-4100
National Provider Directory
National Provider Directory- Part of
- Community Medical Ctr
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245888000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1245888000000",
"number": "1720216005",
"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": "406-728-4100",
"fax_number": "406-327-4545"
},
{
"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": "406-728-4100",
"fax_number": "406-327-4545"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CMC REHAB DEPT NEUROPSYCH EVALUATIONS",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COMMUNITY MEDICAL CENTER",
"enumeration_date": "2009-06-25",
"last_updated": "2009-06-25",
"status": "A",
"authorized_official_last_name": "CARLSON",
"authorized_official_first_name": "STEPHANE",
"authorized_official_middle_name": "G",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "406-728-4100"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist",
"state": "MT",
"license": "226",
"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 Jun 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.