JEFF WATERS (NPI# 1114326691) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114326691 |
| Entity Type | Individual |
| Full Name | JEFF WATERS |
| Practice Address |
2809 Great Northern Loop #200 Missoula MT 59808-1749 |
| Mailing Address |
4265 Muggle Ln Missoula MT 59808-5200 |
| Practice Telephone | 4068300680 |
| Mailing Telephone | 4068300680 |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2014-08-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 247ZC0005X |
Pathology Specialization: Clinical Laboratory Director, Non-physician |
Technologists, Technicians & Other Technical Service Providers |
| Street Address |
2809 GREAT NORTHERN LOOP #200 |
| City | MISSOULA |
| State | MT |
| Zip Code | 59808-1749 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003865171 | George Bandow | Internal Medicine | 2809 Great Northern Loop, Suite 200, Missoula, MT 59808 | 2006-05-08 |
| 1003370396 | Tms Missoula LLC | Clinic/Center | 2809 Great Northern Loop, Ste 410, Missoula, MT 59808-1749 | 2019-01-30 |
| 1184018871 | Compliance Monitoring Systems | Clinical Medical Laboratory | 2809 Great Northern Loop, 200, Missoula, MT 59808-1749 | 2015-03-20 |
| 1326447814 | Jodine Tarbert | Pathology | 2809 Great Northern Loop, #200, Missoula, MT 59808-1749 | 2014-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447720875 | Megan Elizabeth Galliford | Behavioral Analyst | 1647 Shindig Dr, Apt 303, Missoula, MT 59808 | 2018-11-28 |
| 1518473560 | Willow Mahana Nelson Griffith | Registered Nurse | 2829 Great Northern Loop Ste 300, Missoula, MT 59808 | 2017-12-28 |
| 1043739428 | Carol Elizabeth Mckenzie | Student in an Organized Health Care Education/Training Program | 2705 Oshaughnessy St, Missoula, MT 59808 | 2017-09-16 |
| 1558884064 | Sharon Marie Herndon | Nurse Practitioner | 2230 N Reserve St Ste 402, Missoula, MT 59808 | 2017-07-18 |
| 1427594761 | Erin Boggs | Specialist/Technologist | 2921 Dublin St, Missoula, MT 59808 | 2017-01-10 |
| 1942603287 | Benjamin Cody Mcintosh | Chiropractor | 1070 N. Russell St., Missoula, MT 59808 | 2014-10-01 |
| 1518219617 | Pure Medical Inc | Ambulance | 5515 Bonanza Place, Missoula, MT 59808 | 2012-10-12 |
| 1932462231 | Kathleen F Calcagno | Specialist/Technologist | 2615 Connery Way, Suite 2b, Missoula, MT 59808 | 2012-06-21 |
| 1639454127 | Dentyn Dunaway | Pharmacist | 2527 N Reserve Street, Missoula, MT 59808 | 2011-10-15 |
| 1750557690 | Carl Thornblade, Md, Pllc | Allergy & Immunology | 2801 Great Northern Loop Ste 101, Missoula, MT 59808 | 2008-04-30 |
| Find all providers in zip 59808 | ||||
| Taxonomy Code | 247ZC0005X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Pathology |
| Specialization | Clinical Laboratory Director, Non-physician |
| An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments of 1988 for non-physicians (non-MD/DO) as defined in the CFR 42 Part 493.1405. |
| Notes: Source: National Uniform Claim Committee [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326447814 | Jodine Tarbert | Pathology | 2809 Great Northern Loop, #200, Missoula, MT 59808-1749 | 2014-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457821316 | Community Counseling and Correctional Services Inc | Pathology | 200 S Clark St, Butte, MT 59701-1500 | 2018-12-04 |
| 1710311659 | David Michael Korkowski | Pathology | 107 H Street East, Poplar, MT 59255-0067 | 2013-08-28 |
| 1336587740 | Sandra Slay Poyner | Pathology | 107 H Street East, Box 67, Poplar, MT 59255-0067 | 2013-06-07 |
| 1801234257 | Terese Ann Ogrinc-paulus | Pathology | 107 H Street East, Poplar, MT 59255-0067 | 2013-06-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.