MEDICARE: MISSOULA AREA AGENCY ON AGING

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	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447389077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOULA AREA AGENCY ON AGING

Provider Business Mailing Address
First Line	:	337 STEPHENS AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-3816
Country	:	US
Telephone Number	:	406-728-7682
Fax Number	:	406-728-7687

Provider Business Practice Location Address
First Line	:	337 STEPHENS AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-3816
Country	:	US
Telephone Number	:	406-728-7682
Fax Number	:	406-728-7687

Authorized Official
Title or Position	:	ACCOUNTANT
Name	:	KIM FRASER
Credential	:
Telephone Number	:	406-728-7682

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	08/22/2020

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