Healthcare Provider Details

I. General information

NPI: 1104630557
Provider Name (Legal Business Name): NEXT02 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 FORT MISSOULA RD STE 232
MISSOULA MT
59804-7479
US

IV. Provider business mailing address

2831 FORT MISSOULA RD STE 232
MISSOULA MT
59804-7479
US

V. Phone/Fax

Practice location:
  • Phone: 406-404-8588
  • Fax:
Mailing address:
  • Phone: 406-404-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL COLSON
Title or Position: OWNER
Credential:
Phone: 406-404-8588