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General NPI Number Information
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NPI Number | 1346984101
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Entity Type | Organization
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Legal Business Name | FIRST MED LLC
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 2330 S HIGGINS AVE STE 200
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City | MISSOULA
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State | MT
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Zip | 59801-6923
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Country | US
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Telephone | 406-728-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 4540 SOUTH AVE W
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City | MISSOULA
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State | MT
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Zip | 59804-6110
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Country | US
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Telephone | 406-241-0233
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SAMUEL KINGSBURY MILLETT
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Credential | PA-C
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Telephone | 406-241-0233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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