CHARLES BRAD BLACK (NPI# 1356407902) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356407902 |
| Entity Type | Individual |
| Full Name | CHARLES BRAD BLACK |
| Credential | MD |
| Practice Address |
214 E 3rd St Libby MT 59923-2056 |
| Practice Telephone | 4062939274 |
| Practice Fax Number | 4062939280 |
| Mailing Telephone | 4062939274 |
| Mailing Fax Number | 4062939280 |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2013-11-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 4055 | MT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MT | BLUE CROSS BLUE SHIELD MT | 92298 | 01 |
| MT | 00056940 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205094240 | Charles Randall Black | Dentist | 26 Long Pond Road, Plymouth County Correctional Facility, Plymouth, MA 02360-2606 | 2008-05-27 |
| 1962555342 | Charles Leonard Black | Emergency Medicine | 7600 General Motors Blvd, Medical Department, Shreveport, LA 71129-9426 | 2007-01-19 |
| 1053424234 | Charles Glenn Black | Physical Therapist | 1231 Colonial Park Dr, Severn, MD 21144-4417 | 2006-08-15 |
| 1528049723 | Charles Thomas Black | Surgery | 12200 Park Central Dr Ste 400, Dallas, TX 75251-2116 | 2005-11-07 |
| 1972754950 | Charles Black IIi | Dentist | 4728 Airport Blvd, Suite C, Mobile, AL 36608 | 2008-10-08 |
| 1790988087 | Charles Henry Black Iv | Orthopaedic Surgery | 1002 Jefferson St., Suite 350, Laurel, MS 39440-4306 | 2007-06-06 |
| 1427196096 | Charles Alexander Black Jr. | Technician, Other | 427 Commercial St, Boston, MA 02109-1027 | 2007-02-03 |
| 1497764187 | Charles B Black | Surgery | 1010 Three Springs Blvd, Durango, CO 81301-8296 | 2006-08-05 |
| 1730111378 | Charles Joseph Black | Social Worker | 4355 Ferguson Dr, Suite 270, Cincinnati, OH 45245-5136 | 2006-07-06 |
| 1992744981 | Charles Black | Surgery | 1534 Elizabeth Ave, Suite 202, Shreveport, LA 71101-4516 | 2006-06-05 |
| Street Address |
214 E 3RD ST |
| City | LIBBY |
| State | MT |
| Zip Code | 59923-2056 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013197912 | Center for Asbetos Related Disease | Clinic/Center | 214 E 3rd St, Libby, MT 59923-2056 | 2007-11-07 |
| 1194843870 | Michelle Lynn Boltz | Nurse Practitioner | 214 E 3rd St, Libby, MT 59923-2056 | 2007-03-27 |
| 1346368628 | Mark S Heppe | Family Medicine | 214 E 3rd St, Libby, MT 59923-2056 | 2007-03-26 |
| 1316003718 | Alan Coombs Whitehouse | Family Medicine | 214 E 3rd St, Libby, MT 59923-2056 | 2006-12-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518504596 | Office of Randy Guinard, Lcsw LLC | Social Worker | 703 California Avenue, Libby, MT 59923 | 2019-12-09 |
| 1952641615 | Kristi Lynn Lovejoy | Massage Therapist | 952 E Spruce, Libby, MT 59923 | 2013-02-18 |
| 1891943981 | Rita Haidle Billow | Psychologist | 320 E. 2nd Street, Libby, MT 59923 | 2008-09-03 |
| 1225229347 | Mark Serra | Emergency Medicine | 350 Louisiana Avenue, Libby, MT 59923 | 2007-08-05 |
| 1992910319 | Joel A Riddel | Chiropractor | 1115 Minnesota Ave, Libby, MT 59923 | 2007-05-10 |
| 1184743056 | Carol J. Kelly | Counselor | 1469 Highway 2 South, Libby, MT 59923 | 2007-03-29 |
| 1578696464 | Robert Hanley | Counselor | 711 California Avenue, Libby, NE 59923 | 2007-03-13 |
| 1851463947 | Steven L Sorensen | Optometrist | 422 Louisiana Ave, Libby, MT 59923 | 2006-11-14 |
| 1295823979 | Clyde Allen Knecht | Family Medicine | 403 Utah Ave, Libby, MT 59923 | 2006-10-10 |
| 1982717625 | Fisher River Volunteer Fire Company | Ambulance | 100 West Camp Road, Libby, MT 59923 | 2006-08-16 |
| Find all providers in zip 59923 | ||||
| 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 |
|---|---|---|---|---|
| 1295823979 | Clyde Allen Knecht | Family Medicine | 403 Utah Ave, Libby, MT 59923 | 2006-10-10 |
| 1184155442 | Daniel Williams | Family Medicine | 320 E 2nd St, Libby, MT 59923-2010 | 2017-03-27 |
| 1093128076 | Felicia Rhucaya Lucas | Family Medicine | 320 E 2nd St, Libby, MT 59923 | 2014-06-06 |
| 1144665316 | Kelli Jarrett | Family Medicine | 320 E 2nd St, Libby, MT 59923-2010 | 2013-05-01 |
| 1154613842 | Sara H. Mertes | Family Medicine | 350 Louisiana Ave, Libby, MT 59923-2130 | 2011-05-12 |
| 1447577317 | Samantha Lynn Pyle | Family Medicine | 320 E 2nd St, Libby, MT 59923-2010 | 2010-04-30 |
| 1346368628 | Mark S Heppe | Family Medicine | 214 E 3rd St, Libby, MT 59923-2056 | 2007-03-26 |
| 1679602486 | Jay Maloney | Family Medicine | 350 Louisiana Ave, Libby, MT 59923-2130 | 2007-03-05 |
| 1386773190 | Jane Pauline Borish | Family Medicine | 350 Louisiana Ave, Libby, MT 59923-2130 | 2007-03-05 |
| 1316003718 | Alan Coombs Whitehouse | Family Medicine | 214 E 3rd St, Libby, MT 59923-2056 | 2006-12-29 |
| Find all providers in LIBBY | ||||
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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.