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NPI Code Detail

MEDICARE: MERCURY STREET MEDICAL GROUP PLLC

MEDICARE: MERCURY STREET MEDICAL GROUP PLLC
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
1173000000XLegal Medicine

General Provider Information

NPI Number : 1104830793
Entity Type Code : Organization
Provider Name (Legal Business Name) : MERCURY STREET MEDICAL GROUP PLLC
Provider Business Mailing Address
First Line : 300 W MERCURY ST
Second Line :
City : BUTTE
State : MT
Zip : 59701-1652
Country : US
Telephone Number : 406-494-3768
Fax Number : 406-723-1335
Provider Business Practice Location Address
First Line : 3703 HARRISON AVE
Second Line :
City : BUTTE
State : MT
Zip : 59701-6897
Country : US
Telephone Number : 406-494-3768
Fax Number : 406-723-1335
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. SCOTT G BUTLER
Credential :
Telephone Number : 406-723-1300
Provider Enumeration Date : 07/28/2006
Last Update Date : 05/18/2012

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Directions to “MERCURY STREET MEDICAL GROUP PLLC ” Practice Location

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