Provider Demographics
NPI:1053921726
Name:HUTER, TED JOSEPH
Entity type:Individual
Prefix:
First Name:TED
Middle Name:JOSEPH
Last Name:HUTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 PHILLIPS ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2126
Mailing Address - Country:US
Mailing Address - Phone:406-214-2946
Mailing Address - Fax:
Practice Address - Street 1:1700 PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2126
Practice Address - Country:US
Practice Address - Phone:406-214-2946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider