| 406 Recovery | |
|
5 W Mendenhall St Ste 202 Bozeman MT 59715-3566 | |
| (406) 219-7233 | |
| Not Available |
| Full Name | 406 Recovery |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5 W Mendenhall St Ste 202, Bozeman, Montana |
| Authorized Official Name and Position | Robert Sise (CEO) |
| Authorized Official Contact | 2088102319 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 406 Recovery 96 N Weaver St Unit 440 Belgrade MT 59714-7018 Ph: (406) 219-7233 | 406 Recovery 5 W Mendenhall St Ste 202 Bozeman MT 59715-3566 Ph: (406) 219-7233 |
| NPI Number | 1023745247 |
|---|---|
| Provider Enumeration Date | 08/07/2022 |
| Last Update Date | 05/16/2023 |
| Certification Date | 05/16/2023 |
| Medicare PECOS PAC ID | 0042687717 |
|---|---|
| Medicare Enrollment ID | O20221109002096 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023745247 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Primary |
| 2084P0802X | Psychiatry & Neurology - Addiction Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Marc C Mentel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376574871 PECOS PAC ID: 4688657083 Enrollment ID: I20040712000808 |
| Provider Name | Tammera V Nauts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437169968 PECOS PAC ID: 3476507997 Enrollment ID: I20050308000900 |
| Provider Name | Mark A Ackerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679833016 PECOS PAC ID: 7416192380 Enrollment ID: I20150515002162 |
| Provider Name | Robert G Sise |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053725937 PECOS PAC ID: 6800187113 Enrollment ID: I20180807003517 |
| Provider Name | Larisa L Hammond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053801894 PECOS PAC ID: 7719239227 Enrollment ID: I20181011001130 |
| Provider Name | Megan Joy Lehman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922648153 PECOS PAC ID: 2264861301 Enrollment ID: I20200410001572 |
| Provider Name | Heather K Judkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669005526 PECOS PAC ID: 6507270451 Enrollment ID: I20210204000918 |
| Provider Name | Valerie K Kirby-johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073282950 PECOS PAC ID: 0446647119 Enrollment ID: I20220427001572 |
| Provider Name | Robert T Reidenbaugh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487097762 PECOS PAC ID: 0840593927 Enrollment ID: I20230223002404 |
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