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General NPI Number Information
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NPI Number | 1265562177
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Entity Type | Organization
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Legal Business Name | MISSOULA OB-GYN ASSOCIATES
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 2825 FORT MISSOULA RD SUITE 217
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City | MISSOULA
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State | MT
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Zip | 59804-7403
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Country | US
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Telephone | 406-728-8170
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Fax | 406-728-9409
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Provider Business Mailing Address
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Address Line | 2825 FORT MISSOULA RD SUITE 217
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City | MISSOULA
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State | MT
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Zip | 59804-7420
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Country | US
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Telephone | 406-728-8170
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Fax | 406-728-9409
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. HELEN S. KELLY
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Credential |
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Telephone | 406-728-8170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4251
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License Number State | MT
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