MEDICARE: CENTER FOR FAMILY HEALTH, 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	33467	MT
2	305R00000X	Preferred Provider Organization	7628	MT

General Provider Information

NPI Number	:	1285935924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR FAMILY HEALTH, LLC

Provider Business Mailing Address
First Line	:	834 S MONTANA ST
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-2836
Country	:	US
Telephone Number	:	406-723-0123
Fax Number	:	406-723-0211

Provider Business Practice Location Address
First Line	:	834 S MONTANA ST
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-2836
Country	:	US
Telephone Number	:	406-723-0123
Fax Number	:	406-723-0211

Authorized Official
Title or Position	:	FNP
Name	:	CODA E REYNOLDS
Credential	:	FNP
Telephone Number	:	406-723-0123

Provider Enumeration Date	:	11/11/2010
Last Update Date	:	10/17/2011

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