Mission Mountain Medical Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MISSION MOUNTAIN MEDICAL INC

Practice address

38889 Dubay Road
Polson, MT 59860

Phone

(406) 883-2722

Fax

(406) 883-0964

NPI assigned

Jan 8, 2007

Organization subpart

No

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

Authorized official

Name

William Koberg

Title

Owner President

Phone

(406) 883-2722

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189987200000",
    "number": "1831247782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38889 DUBAY ROAD",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "59860",
            "telephone_number": "406-883-2722",
            "fax_number": "406-883-0964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38889 DUBAY ROAD",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "59860",
            "telephone_number": "406-883-2722",
            "fax_number": "406-883-0964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION MOUNTAIN MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-09-17",
        "status": "A",
        "authorized_official_last_name": "KOBERG",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "406-883-2722"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000810475",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Ann McMullen, M.ED. L.P.C.
• Stephanie Lisa McNulty, P.T.
• Emily Marshall Michalik, M.ED.
• Midtown Optometry PLLC
• Mind Flow Therapeutics LLC
• Mission Mountain Recovery and Wellness LLC
• Mission Valley Physical Therapy, PC
• Montana Cancer Specialists
• Montana Dental Group LLC
• Montana Psychiatry Consultation LLC

• Durable Medical Equipment & Medical Supplies in Polson, MT
• Providers in Polson, MT by specialty
• Durable Medical Equipment & Medical Supplies in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2007; 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.