Provider Demographics
NPI:1902134653
Name:JAMES HARKNESS, D.O.P.C.
Entity Type:Organization
Organization Name:JAMES HARKNESS, D.O.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HARKNESS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:406-468-2846
Mailing Address - Street 1:138 ANTELOPE LN
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:MT
Mailing Address - Zip Code:59421-8207
Mailing Address - Country:US
Mailing Address - Phone:406-468-2846
Mailing Address - Fax:406-468-2339
Practice Address - Street 1:138 ANTELOPE LN
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:MT
Practice Address - Zip Code:59421-8207
Practice Address - Country:US
Practice Address - Phone:406-468-2846
Practice Address - Fax:406-468-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0041145Medicaid
MT0041145Medicaid