Provider Demographics
NPI:1114050481
Name:MOUNTAIN MOBILE WOUND CARE
Entity type:Organization
Organization Name:MOUNTAIN MOBILE WOUND CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BEIGHLE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, DPM
Authorized Official - Phone:406-240-4593
Mailing Address - Street 1:1801 SELWAY DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-9314
Mailing Address - Country:US
Mailing Address - Phone:406-240-4593
Mailing Address - Fax:
Practice Address - Street 1:1801 SELWAY DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-9314
Practice Address - Country:US
Practice Address - Phone:406-240-4593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0390422Medicaid
MT000083940Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MT4197030001Medicare NSC
MT0390422Medicaid