Healthcare Provider Details

I. General information

NPI: 1063727279
Provider Name (Legal Business Name): CLANCY L. CONE, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 FORT MISSOULA RD
MISSOULA MT
59804-7420
US

IV. Provider business mailing address

2825 FORT MISSOULA RD
MISSOULA MT
59804-7420
US

V. Phone/Fax

Practice location:
  • Phone: 406-721-1510
  • Fax: 406-721-2115
Mailing address:
  • Phone: 406-721-1510
  • Fax: 406-721-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CLANCY L CONE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 406-721-1510