Momentum Prosthetic Clinic LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

2015-MSS-GEN-00092 Issued in MT

Legal business name

MOMENTUM PROSTHETIC CLINIC LLC

Practice address

3817 Stephens Ave Ste 2
Missoula, MT 59801-8542

Phone

(406) 926-1321

Fax

(406) 926-1327

NPI assigned

Apr 13, 2015

Organization subpart

No

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

Authorized official

Name

Clifford Henry Creekmore, CPO

Title

Practitioner/Managing Member

Phone

(406) 529-0474

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1428883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646179200000",
    "number": "1952797243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3817 STEPHENS AVE STE 2",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598018505",
            "telephone_number": "406-926-1321",
            "fax_number": "406-926-1327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3817 STEPHENS AVE STE 2",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598018542",
            "telephone_number": "406-926-1321",
            "fax_number": "406-926-1327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMENTUM PROSTHETIC CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-13",
        "last_updated": "2022-03-02",
        "certification_date": "2022-02-22",
        "status": "A",
        "authorized_official_last_name": "CREEKMORE",
        "authorized_official_first_name": "CLIFFORD",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "PRACTITIONER/MANAGING MEMBER",
        "authorized_official_telephone_number": "406-529-0474",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MT",
            "license": "2015-MSS-GEN-00092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Monida Healthcare Network Resources
• Monique Krebsbach PT, Inc

• Prosthetic/Orthotic Supplier in Missoula, MT
• Providers in Missoula, MT by specialty
• Prosthetic/Orthotic Supplier in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; 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.