Healthcare Provider Details

I. General information

NPI: 1003226739
Provider Name (Legal Business Name): CHRISTOPHER PAUL BUCKLES HCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 01/25/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 PHEASANT DR
MISSOULA MT
59808-1012
US

IV. Provider business mailing address

8420 PHEASANT DR
MISSOULA MT
59808-1012
US

V. Phone/Fax

Practice location:
  • Phone: 406-880-0184
  • Fax:
Mailing address:
  • Phone: 406-880-0184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: