Provider Demographics
NPI:1366879496
Name:PRAIRIE WINDS MEDICAL LLC
Entity type:Organization
Organization Name:PRAIRIE WINDS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SITZMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-450-0637
Mailing Address - Street 1:706 2ND ST SE
Mailing Address - Street 2:PO BOX 1102
Mailing Address - City:CUT BANK
Mailing Address - State:MT
Mailing Address - Zip Code:59427-3341
Mailing Address - Country:US
Mailing Address - Phone:406-873-5707
Mailing Address - Fax:406-873-3118
Practice Address - Street 1:706 2ND ST SE
Practice Address - Street 2:
Practice Address - City:CUT BANK
Practice Address - State:MT
Practice Address - Zip Code:59427-3341
Practice Address - Country:US
Practice Address - Phone:406-873-5707
Practice Address - Fax:406-873-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-WDD-LIC-19064332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTPHA-WDD-LIC-19064OtherMONTANA PHARMACY LICENSE
MT6991160001Medicare NSC