Healthcare Provider Details

I. General information

NPI: 1225534100
Provider Name (Legal Business Name): CHELSIE LEE RUSSIG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSIE LEE THOMAS DO

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 TALBOT RD
COLUMBIA FALLS MT
59912
US

IV. Provider business mailing address

401 RAILROAD ST W
MISSOULA MT
59802-4109
US

V. Phone/Fax

Practice location:
  • Phone: 406-892-3208
  • Fax:
Mailing address:
  • Phone: 406-258-4789
  • Fax: 406-258-4732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMED-PHYS-LIC-100349
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number100349
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: