MEDICARE: MICARE, LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1942540356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICARE, LLC

Provider Business Mailing Address
First Line	:	2075 OVERLAND AVENUE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102
Country	:	US
Telephone Number	:	406-869-6548
Fax Number	:	406-245-3575

Provider Business Practice Location Address
First Line	:	2075 OVERLAND AVENUE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102
Country	:	US
Telephone Number	:	406-869-6548
Fax Number	:	406-652-5380

Authorized Official
Title or Position	:	DIRECTOR OF MICARE
Name	:	MR. JARROD JASON WEENUM
Credential	:
Telephone Number	:	406-869-6548

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	02/21/2013

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