| NPI | 1053341222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY L PEDERSON Practice Manager 406-771-7300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2025-09-11 |