Healthcare Provider Details

I. General information

NPI: 1639254709
Provider Name (Legal Business Name): TIMOTHY J MCCUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 S RESERVE ST
MISSOULA MT
59801-4756
US

IV. Provider business mailing address

629D LOWTHER RD
LEWISBERRY PA
17339-9527
US

V. Phone/Fax

Practice location:
  • Phone: 406-540-4117
  • Fax:
Mailing address:
  • Phone: 303-914-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10429
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number10429
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMED-PHYS-LIC-10429
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: