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NPI Code Detail

MEDICARE: MISSOULA URBAN INDIAN HEALTH CENTER, INC.

MEDICARE: MISSOULA URBAN INDIAN HEALTH CENTER, INC.
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center224-15MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285769786
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSOULA URBAN INDIAN HEALTH CENTER, INC.
Provider Business Mailing Address
First Line : 830 W CENTRAL AVE
Second Line :
City : MISSOULA
State : MT
Zip : 59801-7931
Country : US
Telephone Number : 406-829-9515
Fax Number : 406-829-9519
Provider Business Practice Location Address
First Line : 830 W CENTRAL AVE
Second Line :
City : MISSOULA
State : MT
Zip : 59801-7931
Country : US
Telephone Number : 406-829-9515
Fax Number : 406-829-9519
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. LEEANN BRUISED HEAD
Credential : MPH
Telephone Number : 406-829-9515
Provider Enumeration Date : 02/23/2007
Last Update Date : 11/18/2015

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