Healthcare Provider Details

I. General information

NPI: 1568937126
Provider Name (Legal Business Name): VICTORIA CALLAHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W KENT AVE
MISSOULA MT
59801-6772
US

IV. Provider business mailing address

700 W KENT AVE
MISSOULA MT
59801-6772
US

V. Phone/Fax

Practice location:
  • Phone: 406-541-3277
  • Fax: 406-541-3811
Mailing address:
  • Phone: 406-541-3277
  • Fax: 406-541-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMED-PAC-LIC-166127
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: