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General NPI Number Information
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NPI Number | 1194540120
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Entity Type | Organization
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Legal Business Name | BASECAMP PEDIATRICS
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 2230 27TH AVE STE 3
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City | MISSOULA
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State | MT
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Zip | 59804-5128
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Country | US
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Telephone | 406-214-4577
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Fax |
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Provider Business Mailing Address
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Address Line | 110 E KENT AVE
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City | MISSOULA
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State | MT
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Zip | 59801-6028
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Country | US
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Telephone | 406-240-1229
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Fax |
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Authorized Official
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Title or Position | OWNER, PNP
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Name | TARA PATRICK
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Credential | PNP
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Telephone | 406-240-1229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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