Healthcare Provider Details

I. General information

NPI: 1700906476
Provider Name (Legal Business Name): POWELL COUNTY FAMILY PLANNNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MILWAUKEE
DEER LODGE MT
59722-1069
US

IV. Provider business mailing address

305 MILWAUKEE
DEER LODGE MT
59722
US

V. Phone/Fax

Practice location:
  • Phone: 406-846-2420
  • Fax: 406-846-3436
Mailing address:
  • Phone: 406-846-2420
  • Fax: 406-846-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN11730
License Number StateMT

VIII. Authorized Official

Name: JAMIE J PAUL
Title or Position: DIRECTOR
Credential:
Phone: 406-497-5080