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General NPI Number Information
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NPI Number | 1093697468
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Entity Type | Organization
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Legal Business Name | PURE INFUSION OF MONTANA LLC
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 100 BROOKSHIRE BLVD BLDG 2 UNIT 1 BLDG 2 UNIT 1
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City | BILLINGS
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State | MT
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Zip | 59102
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Country | US
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Telephone | 406-702-1327
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Fax |
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Provider Business Mailing Address
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Address Line | 4179 S RIVERBOAT RD STE 220
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-2986
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Country | US
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Telephone | 801-590-9267
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PAYER DEVELOPMENT
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Name | RACHEL ANN FRAGA
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Credential |
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Telephone | 801-921-6325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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