Healthcare Provider Details

I. General information

NPI: 1013197912
Provider Name (Legal Business Name): THE CENTER FOR ASBESTOS RELATED DISEASE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E 3RD ST
LIBBY MT
59923-2056
US

IV. Provider business mailing address

214 E 3RD ST
LIBBY MT
59923-2056
US

V. Phone/Fax

Practice location:
  • Phone: 406-293-9274
  • Fax: 406-293-9280
Mailing address:
  • Phone: 406-293-9274
  • Fax: 406-293-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHAEL SHELMERDINE
Title or Position: PATIENT ACCOUNT REPRESENTATIVE
Credential:
Phone: 406-293-9274