MEDICARE: MISSOULA COMMUNITY HEALTH SERVICES, INC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1710165105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOULA COMMUNITY HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 66
Second Line	:
City	:	SUPERIOR
State	:	MT
Zip	:	59872-0066
Country	:	US
Telephone Number	:	406-822-4278
Fax Number	:	406-822-4912

Provider Business Practice Location Address
First Line	:	1208 6TH AVE
Second Line	:
City	:	SUPERIOR
State	:	MT
Zip	:	59872-9618
Country	:	US
Telephone Number	:	406-822-4278
Fax Number	:	406-822-4912

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN S MCNEECE
Credential	:
Telephone Number	:	406-822-4841

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	04/05/2019

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