Healthcare Provider Details

I. General information

NPI: 1447314174
Provider Name (Legal Business Name): RANDY J LOVELL DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 MAIN STREET
THOMPSON FALLS MT
59873-0969
US

IV. Provider business mailing address

PO BOX 969
THOMPSON FALLS MT
59873-0969
US

V. Phone/Fax

Practice location:
  • Phone: 406-827-4307
  • Fax:
Mailing address:
  • Phone: 406-827-4307
  • Fax: 406-827-9514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6022
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number439
License Number StateMT

VIII. Authorized Official

Name: WANDA K LARSEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 406-827-4307