Provider Demographics
NPI:1144276635
Name:VALERIE ANN KNUDSEN MD FACOG PLLC
Entity type:Organization
Organization Name:VALERIE ANN KNUDSEN MD FACOG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANIG
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CHBME
Authorized Official - Phone:406-443-3076
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624-1130
Mailing Address - Country:US
Mailing Address - Phone:406-443-3076
Mailing Address - Fax:406-449-6531
Practice Address - Street 1:2831 FORT MISSOULA RD
Practice Address - Street 2:SUITE 306
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7419
Practice Address - Country:US
Practice Address - Phone:406-327-4395
Practice Address - Fax:406-327-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5310207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0042245Medicaid
ID0021863Medicaid
MT0042245Medicaid