Healthcare Provider Details

I. General information

NPI: 1861511669
Provider Name (Legal Business Name): ANACONDA DEER LODGE CO FAMILY PLANNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E 7TH ST STE 1E
ANACONDA MT
59711-2953
US

IV. Provider business mailing address

118 E 7TH ST STE 1E
ANACONDA MT
59711-2953
US

V. Phone/Fax

Practice location:
  • Phone: 406-563-7863
  • Fax: 406-563-2387
Mailing address:
  • Phone: 406-563-7863
  • Fax: 406-563-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN11730
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: LAUREN BOLTON
Title or Position: DIRECTOR
Credential:
Phone: 406-563-7863