Provider Demographics
NPI:1184797771
Name:BILLINGS OTOLARYNGOLOGY PC
Entity type:Organization
Organization Name:BILLINGS OTOLARYNGOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BYORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-238-6270
Mailing Address - Street 1:2900 12TH AVE N STE 290W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7501
Mailing Address - Country:US
Mailing Address - Phone:406-238-6270
Mailing Address - Fax:406-238-6279
Practice Address - Street 1:2900 12TH AVE N STE 290W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7501
Practice Address - Country:US
Practice Address - Phone:406-238-6270
Practice Address - Fax:406-238-6279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7754207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT005967OtherBLUE CROSS BLUE SHIELD
MT0000070226Medicaid
MT005967OtherBLUE CROSS BLUE SHIELD