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NPI Code Detail

MEDICARE: WESTERN MONTANA CLINIC PC

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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1942253182
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 : 406-721-5600
Fax Number : 406-721-3907
Provider Business Practice Location Address
First Line : 500 WEST BROADWAY
Second Line :
City : MISSOULA
State : MT
Zip : 59802-4008
Country : US
Telephone Number : 406-721-5600
Fax Number : 406-721-3907
Authorized Official
Title or Position : PRESIDENT
Name : DR. DIRK GOTTMAN
Credential : MD
Telephone Number : 406-721-5600
Provider Enumeration Date : 05/18/2006
Last Update Date : 07/06/2021

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Directions to “WESTERN MONTANA CLINIC PC ” Practice Location

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