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General NPI Number Information
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NPI Number | 1427294792
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Entity Type | Organization
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Legal Business Name | MAIN STREET CLINIC
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 12/16/2008
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Provider Practice Location Address
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Address Line | 11 W MAIN ST SUITE 225
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City | BELGRADE
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State | MT
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Zip | 59714-3700
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Country | US
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Telephone | 406-388-6151
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Fax |
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Provider Business Mailing Address
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Address Line | 11 W MAIN ST SUITE 225
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City | BELGRADE
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State | MT
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Zip | 59714-3700
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Country | US
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Telephone | 406-388-6151
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. MARC CHARLES MENTEL
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Credential | D.O.
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Telephone | 406-570-1639
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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 | 10584
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License Number State | MT
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