MEDICARE: NOAH VISSCHER MSA

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	171100000X	Acupuncturist	AC61123606	WA
2	171100000X	Acupuncturist	MED-ACU-LIC-104849	MT

General Provider Information

NPI Number	:	1124303870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOAH VISSCHER MSA

Provider Business Mailing Address
First Line	:	145 MILL TOWN LOOP STE A
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-5144
Country	:	US
Telephone Number	:	406-587-1167
Fax Number	:	406-219-0935

Provider Business Practice Location Address
First Line	:	145 MILL TOWN LOOP STE A
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-5144
Country	:	US
Telephone Number	:	406-587-1167
Fax Number	:	406-219-0935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2011
Last Update Date	:	06/24/2022

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Directions to “ NOAH VISSCHER MSA” Practice Location

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