Healthcare Provider Details

I. General information

NPI: 1366761686
Provider Name (Legal Business Name): WESTERN MONTANA CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11350 US HIGHWAY 93 S LOLO FAMILY PRACTICE
LOLO MT
59847-9689
US

IV. Provider business mailing address

PO BOX 7609
MISSOULA MT
59807-7609
US

V. Phone/Fax

Practice location:
  • Phone: 406-273-0045
  • Fax:
Mailing address:
  • Phone: 406-721-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOYCE E STEVENS
Title or Position: DIRECTOR ANCILLARY & SATELLITE SERV
Credential:
Phone: 406-721-5600