DR. EDRED T VIZCARRA (NPI# 1043373111) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043373111 |
| Entity Type | Individual |
| Full Name | DR. EDRED T VIZCARRA |
| Credential | MD |
| Practice Address |
126 6th Ave Sw Ronan MT 59864-2600 |
| Mailing Address |
48767 Rocky Butte Rd Ronan MT 59864-8897 |
| Practice Telephone | 4066763600 |
| Practice Fax Number | 4066763738 |
| Mailing Telephone | 4066760432 |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 6860 | MT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MT | 101257 | 05 |
| Street Address |
126 6TH AVE SW |
| City | RONAN |
| State | MT |
| Zip Code | 59864-2600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952367450 | Michael J O'connor | Surgery | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2006-04-24 |
| 1649741927 | Leigh A Kenning | Social Worker | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2018-12-11 |
| 1043769847 | Gage Henderson | Physician Assistant | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2016-09-22 |
| 1972052777 | Meagan Lavin Henderson | Physician Assistant | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2016-09-22 |
| 1447630868 | Joanna Billings | Family Medicine | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2015-06-01 |
| 1295112944 | Laura I Hoganson | Family Medicine | 126 6th Ave Sw, Ronan, MT 59864 | 2015-05-01 |
| 1386055481 | Brenda B Olsen | Social Worker | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2014-05-12 |
| 1326464397 | Shanley Swanson | Counselor | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2014-03-13 |
| 1023450798 | Megan A Vigil | Family Medicine | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2013-07-23 |
| 1669773651 | Providence Health & Services Mt | General Acute Care Hospital | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2010-11-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437676566 | Kristin A. Murphy | Registered Nurse | 35860 Round Butte Rd., Ronan, MT 59864 | 2017-08-29 |
| 1477906725 | Richard A Greene IIi | Counselor | 407 Main St Sw, Ronan, MT 59864 | 2016-07-21 |
| 1134592942 | Sancee Leigh Heaton | Massage Therapist | 41064 Us Hwy93 Frontage Rd, Ronan, MT 59864 | 2015-11-03 |
| 1700160033 | Rosemary Epperson | Social Worker | 1313 Us-93, Ronan, MT 59864 | 2011-10-05 |
| 1700109790 | Cyndi Lu Marengo | Dental Hygienist | 380 Mission Drive, St. Ignatius, MT 59864 | 2010-03-05 |
| 1841335973 | Katherine Stacy Kiser | Counselor | 530 Highway 93 South, Ronan, MT 59864 | 2007-02-20 |
| 1376682351 | Stanley Houston Fleming | Counselor | 30 Round Butte Road West, Ronan, MT 59864 | 2007-02-06 |
| 1255477907 | Vanessa Anne Courville | Registered Nurse | 28 Round Butte Rd, Ronan, MT 59864 | 2007-01-29 |
| 1114074903 | Robert Duane Gerrie | Surgery | # 6 Thirteenth Ave. E., Polson, MT 59864 | 2007-01-04 |
| 1740341189 | Eleanore R Hobbs | Psychiatry & Neurology | 126 6th Ave. Sw, St. Luke Community Clinci Ronan, Ronan, MT 59864 | 2006-12-12 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881175735 | Geofrey William Rohrlach | Family Medicine | 104 Main St Sw, Ronan, MT 59864-2703 | 2018-08-28 |
| 1447630868 | Joanna Billings | Family Medicine | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2015-06-01 |
| 1295112944 | Laura I Hoganson | Family Medicine | 126 6th Ave Sw, Ronan, MT 59864 | 2015-05-01 |
| 1467894121 | Benjamin D Grass | Family Medicine | 107 6th Ave Sw, Ronan, MT 59864-2634 | 2013-07-23 |
| 1023450798 | Megan A Vigil | Family Medicine | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2013-07-23 |
| 1972738532 | Terrence James O'malia | Family Medicine | 107 6th Ave Sw, Ronan, MT 59864-2634 | 2009-05-26 |
| 1588864979 | John G. Foster | Family Medicine | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2007-07-23 |
| 1750445367 | Rial W Cummings | Family Medicine | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2006-12-20 |
| 1295897650 | Hikmat A Maaliki | Family Medicine | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2006-12-14 |
| 1174685374 | William C Cullis | Family Medicine | 126 6th Ave Sw, Ronan, MT 59864-2600 | 2006-12-14 |
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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.