Healthcare Provider Details

I. General information

NPI: 1053061119
Provider Name (Legal Business Name): EMILY BALON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 OSLOSKI RD
EUREKA MT
59917-9217
US

IV. Provider business mailing address

401 RAILROAD ST W
MISSOULA MT
59802-4178
US

V. Phone/Fax

Practice location:
  • Phone: 406-297-3145
  • Fax: 406-297-3364
Mailing address:
  • Phone: 406-584-4789
  • Fax: 406-258-4732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number162368
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: