MEDICARE: PURE INFUSION OF MONTANA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1093697468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE INFUSION OF MONTANA LLC

Provider Business Mailing Address
First Line	:	4179 S RIVERBOAT RD STE 220
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84123-2986
Country	:	US
Telephone Number	:	801-590-9267
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 BROOKSHIRE BLVD BLDG 2 UNIT 1
Second Line	:	BLDG 2 UNIT 1
City	:	BILLINGS
State	:	MT
Zip	:	59102
Country	:	US
Telephone Number	:	406-702-1327
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PAYER DEVELOPMENT
Name	:	RACHEL ANN FRAGA
Credential	:
Telephone Number	:	801-921-6325

Provider Enumeration Date	:	07/24/2025
Last Update Date	:	12/09/2025

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