MEDICARE: WESTERN MONTANA CLINIC PC

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1619144821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN MONTANA CLINIC PC

Provider Business Mailing Address
First Line	:	PO BOX 7609
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59807-7609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 BROOKS ST
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-7722
Country	:	US
Telephone Number	:	406-721-5600
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JOYCE E STEVENS
Credential	:
Telephone Number	:	406-721-5600

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	05/15/2008

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