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General NPI Number Information
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NPI Number | 1063083418
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Entity Type | Organization
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Legal Business Name | BIOME GROUP HEALTH, PLLC
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Dates
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Enumeration Date | 07/07/2021
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 2831 FORT MISSOULA RD. BLDG. 2 STE. 203
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City | MISSOULA
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State | MT
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Zip | 59804-7479
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Country | US
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Telephone | 480-628-3002
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9352
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City | MISSOULA
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State | MT
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Zip | 59807-9352
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Country | US
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Telephone | 406-544-6214
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MARISSA COLLEEN CAVALIER
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Credential | ND
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Telephone | 480-628-3002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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