Healthcare Provider Details

I. General information

NPI: 1134788185
Provider Name (Legal Business Name): PIRA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 FORT MISSOULA RD STE 201
MISSOULA MT
59804-7403
US

IV. Provider business mailing address

2825 FORT MISSOULA RD STE 201
MISSOULA MT
59804-7403
US

V. Phone/Fax

Practice location:
  • Phone: 208-557-9898
  • Fax:
Mailing address:
  • Phone: 208-557-9898
  • 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
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN GUY LOOSLI
Title or Position: EXECUTIVE DIRECTOR
Credential: MSC
Phone: 406-763-8833