Healthcare Provider Details

I. General information

NPI: 1922388941
Provider Name (Legal Business Name): KAREN MYERS MT (ASCP)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 CLINIC RD E
BOX ELDER MT
59521-8826
US

IV. Provider business mailing address

535 CLINIC RD E
BOX ELDER MT
59521-8826
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-4486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number410
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberLPT 1810
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: