Healthcare Provider Details

I. General information

NPI: 1982610770
Provider Name (Legal Business Name): 341 MEDICAL GROUP MAFB AFB, MT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 FOX FARM RD
GREAT FALLS MT
59404-3323
US

IV. Provider business mailing address

1709 FOX FARM ROAD
GREAT FALLS MT
59404
US

V. Phone/Fax

Practice location:
  • Phone: 406-731-3219
  • Fax:
Mailing address:
  • Phone: 406-731-3219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberI-3035
License Number StateNM

VIII. Authorized Official

Name: ANTHONY CHRISTOPHER WILSON
Title or Position: FAMILY ADVOCACY OFFICER
Credential:
Phone: 406-731-3219