| NPI | 1073080461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY CONROW-VERVERIS CFO 406-822-4841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2022-10-12 |