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NPI Code Detail

MEDICARE: INTERMOUNTAIN COMMUNITY CLINIC

MEDICARE: INTERMOUNTAIN COMMUNITY CLINIC
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1548544760
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERMOUNTAIN COMMUNITY CLINIC
Provider Business Mailing Address
First Line : 3240 DREDGE DR
Second Line :
City : HELENA
State : MT
Zip : 59602-0548
Country : US
Telephone Number : 406-442-7920
Fax Number : 406-442-7949
Provider Business Practice Location Address
First Line : 3240 DREDGE DR
Second Line :
City : HELENA
State : MT
Zip : 59602-0548
Country : US
Telephone Number : 406-442-7920
Fax Number : 406-442-7949
Authorized Official
Title or Position : CAO
Name : JENNIFER WILLIAMS
Credential :
Telephone Number : 406-457-4822
Provider Enumeration Date : 10/06/2011
Last Update Date : 11/28/2023

Similar Medicare Providers

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1790066801 — MEGHAN ANN ERICKSON APRN
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59602-0548
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Directions to “INTERMOUNTAIN COMMUNITY CLINIC ” Practice Location

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