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General NPI Number Information
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NPI Number | 1700762200
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Entity Type | Organization
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Legal Business Name | MISSOULA SPORTS MEDICINE AND IMAGING LLC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 1510 S RESERVE ST
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City | MISSOULA
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State | MT
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Zip | 59801-4756
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Country | US
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Telephone | 406-540-4117
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 S RESERVE ST
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City | MISSOULA
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State | MT
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Zip | 59801-4756
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Country | US
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Telephone | 406-540-4117
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | TIMOTHY J MCCUE
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Credential |
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Telephone | 406-540-4117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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