Mark E Vandolah, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

RN14372 Issued in MT

Practice address

7 Vandolah Road
Three Forks, MT 59752-1330

Phone

(406) 285-6588

Fax

(406) 285-9012

NPI assigned

Feb 16, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Butte Pain and Anesthesia Associates, PLLC

  • Anesthesiology Physician
  • Butte, MT
  • NPI 1205869468
  NPD (past)
• Mike Mondloch, Crna, Inc

  • Certified Registered Nurse Anesthetist
  • Missoula, MT
  • NPI 1295768448

  Nurse Anesthetist, Certified Registered

  NPD (past)

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

{
    "created_epoch": "1140048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205193600000",
    "number": "1891769600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1330",
            "address_2": "7 VANDOLAH ROAD",
            "city": "THREE FORKS",
            "state": "MT",
            "postal_code": "597521330",
            "telephone_number": "406-285-6588",
            "fax_number": "406-285-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 VANDOLAH ROAD",
            "city": "THREE FORKS",
            "state": "MT",
            "postal_code": "597521330",
            "telephone_number": "406-285-6588",
            "fax_number": "406-285-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDOLAH",
        "first_name": "MARK",
        "middle_name": "E",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-16",
        "last_updated": "2008-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MT",
            "license": "RN14372",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4308525",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Three Forks Public Schools
• Three Forks School District #J24
• Three Forks School District #J24
• Three Rivers Clinic LLC
• Tobacco Root Anesthesiology, LLC
• Tina Cecilie Wambeke
• Shannon Rose Zuelke, PTA

• All providers in Three Forks, MT
• Certified Registered Nurse Anesthetist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; 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.