MOUNTAINSIDE MEDICAL LLC NPI 1487482543

NPI Information

  • NPI: 1487482543
  • Provider Name: MOUNTAINSIDE MEDICAL, LLC
  • Classification: Nurse Practitioner - 363LA2200X
  • Specialization: Adult Health
  • Entity Type: Organization
  • CLIA Number: 27D2315683
  • Address: 704 MAIN ST
    STEVENSVILLE, MT
    ZIP 59870
  • Phone: (406) 303-9781

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NPI Details

MOUNTAINSIDE MEDICAL, LLC is an adult health nurse practitioner in Stevensville, MT. MOUNTAINSIDE MEDICAL, LLC NPI is 1487482543. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

704 MAIN ST
STEVENSVILLE, MT
ZIP 59870-828
Phone: (406) 303-9781
Fax: (880) 440-2614

The provider's authorized official is Carson C Gomez .
The authorized official title is Owner and has the following contact phone number (406) 303-9781.

The CLIA number assigned to this NPI record is 27D2315683 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/22/2024 and was last updated on 12/10/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LA2200XNurse PractitionerAdult HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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