NPIMap

Organization Active NPI

Carl Thornblade, MD, PLLC

Doing business as Montana Allergy Practice

  • Allergy & Immunology Physician
  • Missoula, MT
National Provider Identifier
1750557690
Registry record updated Feb 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
11594 Issued in MT
Legal business name
CARL THORNBLADE, MD, PLLC
Doing business as
Montana Allergy Practice
Practice address
2801 Great Northern Loop Ste 101
Missoula, MT 59808
Phone
(406) 728-6472
Fax
(406) 728-9175
NPI assigned
Apr 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2019

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

Authorized official

Name
Dr. Carl Edward Thornblade, MDNPI 1073605200
Title
Allergist/Owner
Phone
(406) 728-6472

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207K00000X 11594 MT Primary

Addresses

Primary practice location

2801 Great Northern Loop Ste 101
Missoula, MT 59808

Mailing address

2801 Great Northern Loop Ste 101
Missoula, MT 59808-1745
Phone (406) 728-6472

Other practice location 1

610 W Spruce St
Missoula, MT 59802-4009
Phone (406) 728-6472

Other names 1

  • Montana Allergy Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080603000067 MT Part B Supplier - Clinic/Group Practice 3375613342 Receives reassigned benefits from 5 practitioners
Practice locations: Missoula, MT

National Provider Directory

National Provider Directory

Locations

2801 Great Northern Loop
Unit 100
Missoula, MT 59808

2801 Great Northern Loop
Ste 101
Missoula, MT 59808
Phone (406) 728-6472

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549238400000",
    "number": "1750557690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 GREAT NORTHERN LOOP STE 101",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081745",
            "telephone_number": "406-728-6472",
            "fax_number": "406-728-9175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 GREAT NORTHERN LOOP STE 101",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59808",
            "telephone_number": "406-728-6472",
            "fax_number": "406-728-9175"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "610 W Spruce St",
            "address_purpose": "LOCATION",
            "city": "Missoula",
            "state": "MT",
            "postal_code": "598024009",
            "country_code": "US",
            "telephone_number": "406-728-6472",
            "fax_number": "406-728-9175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CARL THORNBLADE, MD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2019-02-04",
        "status": "A",
        "authorized_official_last_name": "THORNBLADE",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "ALLERGIST/OWNER",
        "authorized_official_telephone_number": "406-728-6472",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology",
            "state": "MT",
            "license": "11594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Montana Allergy Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Montana Allergy Practice",
            "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 Feb 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.