Healthcare Provider Details

I. General information

NPI: 1093697468
Provider Name (Legal Business Name): PURE INFUSION OF MONTANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BROOKSHIRE BLVD BLDG 2 UNIT 1 BLDG 2 UNIT 1
BILLINGS MT
59102
US

IV. Provider business mailing address

4179 S RIVERBOAT RD STE 220
TAYLORSVILLE UT
84123-2986
US

V. Phone/Fax

Practice location:
  • Phone: 406-702-1327
  • Fax:
Mailing address:
  • Phone: 801-590-9267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHEL ANN FRAGA
Title or Position: DIRECTOR OF PAYER DEVELOPMENT
Credential:
Phone: 801-921-6325