Healthcare Provider Details

I. General information

NPI: 1609327428
Provider Name (Legal Business Name): USAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N PERIMETER RD
GREAT FALLS MT
59402-6701
US

IV. Provider business mailing address

7300 N PERIMETER RD
GREAT FALLS MT
59402-6701
US

V. Phone/Fax

Practice location:
  • Phone: 406-731-2309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name: APRIL WELCH
Title or Position: IDMT
Credential:
Phone: 940-232-8515