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General NPI Number Information
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NPI Number | 1306818034
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Entity Type | Organization
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Legal Business Name | LIBBY CLINIC
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 211 E 2ND ST
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City | LIBBY
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State | MT
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Zip | 59923
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Country | US
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Telephone | 406-293-8711
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Fax | 406-293-8735
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Provider Business Mailing Address
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Address Line | 211 E 2ND ST
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City | LIBBY
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State | MT
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Zip | 59923-2047
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Country | US
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Telephone | 406-293-8711
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Fax | 406-293-8735
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MYRESA C BOULWARE
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Credential |
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Telephone | 406-293-8711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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