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General NPI Number Information
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NPI Number | 1972811420
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Entity Type | Organization
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Legal Business Name | PREMIER CARE PEDIATRICS & FAMILY PRACTICE
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Dates
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Enumeration Date | 09/17/2010
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 1300 28TH ST S SUITE 6
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City | GREAT FALLS
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State | MT
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Zip | 59405-5296
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Country | US
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Telephone | 406-455-5437
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Fax | 406-455-4365
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Provider Business Mailing Address
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Address Line | 1300 28TH ST S SUITE 6
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City | GREAT FALLS
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State | MT
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Zip | 59405-5296
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Country | US
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Telephone | 406-455-5437
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Fax | 406-455-4365
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JILL SIMMONS
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Credential |
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Telephone | 406-455-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN13634
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 8726
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License Number State | MT
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