NPIMap

Organization Active NPI

Western Montana Clinic PC

Doing business as Western Montana Clinic Laboratory

  • Clinical Medical Laboratory
  • Missoula, MT
National Provider Identifier
1740364017
Registry record updated Sep 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
WESTERN MONTANA CLINIC PC
Doing business as
Western Montana Clinic Laboratory
Practice address
500 W Broadway St
Missoula, MT 59802-4008
Phone
(406) 721-5600
Fax
(406) 721-3907
NPI assigned
Oct 24, 2006
Last updated
Sep 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2016

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

Authorized official

Name
Adam Vanregenmorter, PH.D.
Title
Laboratory Director
Phone
(406) 721-5600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

500 W Broadway St
Missoula, MT 59802-4008

Mailing address

PO Box 7609
Missoula, MT 59807-7609
Phone (406) 721-5600

Other names 1

  • Western Montana Clinic Laboratory Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100209000415 MT Part B Supplier - Independent Clinical Laboratory 2466365002 Practice locations: Missoula, MT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
27D0690353Western Montana Clinic Broadway BLDG500 West Broadway, Missoula, MT 59802ComplianceDec 1, 2026
27D2095428Western Montana Clinic Nowcare Downtown500 West Broadway, Missoula, MT 59802Provider-performed microscopyMay 5, 2027
27D2099606Western Montana Clinic OBGYN500 W Broadway, Missoula, MT 59802Certificate of waiverJul 31, 2027
27D2107905Western Montana Clinic Pathology500 West Broadway, Missoula, MT 59802ComplianceMay 17, 2028

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

500 W Broadway St
Fl 2
Missoula, MT 59802
Phone (406) 728-2539

Practitioners & affiliated clinicians

Practitioners 71

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 71

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472774400000",
    "number": "1740364017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7609",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598077609",
            "telephone_number": "406-721-5600",
            "fax_number": "406-721-3907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-721-5600",
            "fax_number": "406-721-3907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN MONTANA CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2016-09-02",
        "status": "A",
        "authorized_official_last_name": "VANREGENMORTER",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "LABORATORY DIRECTOR",
        "authorized_official_telephone_number": "406-721-5600",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Montana Clinic Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 2, 2016; 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.