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General NPI Number Information
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NPI Number | 1760493225
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Entity Type | Organization
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Legal Business Name | MISSOULA FAMILY MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 04/19/2010
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Provider Practice Location Address
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Address Line | 621 W ALDER ST
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City | MISSOULA
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State | MT
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Zip | 59802-4014
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Country | US
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Telephone | 406-728-3111
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Fax | 406-728-3116
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Provider Business Mailing Address
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Address Line | 621 W ALDER ST
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City | MISSOULA
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State | MT
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Zip | 59802-4014
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Country | US
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Telephone | 406-728-3111
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Fax | 406-728-3116
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MICHAEL ROBERT PRIDDY
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Credential | M.D.
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Telephone | 406-728-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4963
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License Number State | MT
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