MEDICARE: IDEAL OPTION, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1205352689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL OPTION, PLLC

Provider Business Mailing Address
First Line	:	5615 DUNBARTON AVE
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-8216
Country	:	US
Telephone Number	:	509-570-9302
Fax Number	:	509-491-3031

Provider Business Practice Location Address
First Line	:	301 SADDLE DR STE G
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-8026
Country	:	US
Telephone Number	:	877-522-1275
Fax Number	:	509-491-3031

Authorized Official
Title or Position	:	CMO
Name	:	BRIAN JEFFERSON DAWSON
Credential	:	MD
Telephone Number	:	509-222-1275

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	08/30/2023

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