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General NPI Number Information
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NPI Number | 1144260514
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASE SPECIALISTS, PC
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 614 W SPRUCE ST
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City | MISSOULA
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State | MT
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Zip | 59802-4002
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Country | US
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Telephone | 406-327-1666
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Fax | 406-329-5606
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Provider Business Mailing Address
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Address Line | PO BOX 8897
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City | MISSOULA
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State | MT
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Zip | 59807-8897
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Country | US
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Telephone | 406-721-6221
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Fax | 406-721-6221
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MS. WILLA CRAIG
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Credential | MBA
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Telephone | 406-721-6221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 6638
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License Number State | MT
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