Healthcare Provider Details

I. General information

NPI: 1619166972
Provider Name (Legal Business Name): PERFORMANCE INJURY CARE & SPORTS MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N MONTANA AVE SUITE A
HELENA MT
59602-7804
US

IV. Provider business mailing address

3150 N MONTANA AVE SUITE A
HELENA MT
59602-7804
US

V. Phone/Fax

Practice location:
  • Phone: 406-422-5817
  • Fax: 406-422-5928
Mailing address:
  • Phone: 406-422-5817
  • Fax: 406-422-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JAMIE BRAGG
Title or Position: PRACTICE MANAGER
Credential:
Phone: 406-422-5817