Healthcare Provider Details

I. General information

NPI: 1275559676
Provider Name (Legal Business Name): THREE RIVERS ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 FAIRVIEW AVE SUITE A
MISSOULA MT
59801-7872
US

IV. Provider business mailing address

1724 FAIRVIEW AVE SUITE A
MISSOULA MT
59801-7872
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-0120
  • Fax: 406-327-0117
Mailing address:
  • Phone: 406-327-0120
  • Fax: 406-327-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10706
License Number StateMT

VIII. Authorized Official

Name: ROY R HALL
Title or Position: OWNER
Credential: M.D.
Phone: 406-327-0120