Healthcare Provider Details

I. General information

NPI: 1790755445
Provider Name (Legal Business Name): JANE C WELLS MD MHS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SOUTH AVENUE WEST SUITE B
MISSOULA MT
59801
US

IV. Provider business mailing address

700 SOUTH AVENUE WEST SUITE B
MISSOULA MT
59801
US

V. Phone/Fax

Practice location:
  • Phone: 406-541-6220
  • Fax: 406-541-6221
Mailing address:
  • Phone: 406-541-6220
  • Fax: 406-541-6221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9676
License Number StateMT

VIII. Authorized Official

Name: DR. JANE CAMERON WELLS
Title or Position: MEMBER
Credential: MS MHA
Phone: 406-541-6220