MEDICARE: BASECAMP PEDIATRICS

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1194540120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASECAMP PEDIATRICS

Provider Business Mailing Address
First Line	:	110 E KENT AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-6028
Country	:	US
Telephone Number	:	406-240-1229
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 27TH AVE STE 3
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-5128
Country	:	US
Telephone Number	:	406-214-4577
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PNP
Name	:	TARA PATRICK
Credential	:	PNP
Telephone Number	:	406-240-1229

Provider Enumeration Date	:	11/15/2024
Last Update Date	:	11/15/2024

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