| NPI | 1104299965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE PHILBIN-VULPIS Owner 406-493-0025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: AZ 4034) |
| Additional Taxonomies | 251E00000X Home Health (Licence: AZ 4034) |
| 251G00000X Hospice Care, Community Based (Licence: AZ 4034) | |
| 251S00000X (Licence: AZ 4034) | |
| 261QI0500X Clinic/Center, Infusion Therapy (Licence: AZ 4034) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: AZ 4034) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: AZ 4034) | |
| 261QR1300X Clinic/Center, Rural Health (Licence: AZ 4034) | |
| 261QS1200X Clinic/Center, Sleep Disorder Diagnostic (Licence: AZ 4034) | |
| 261QV0200X Clinic/Center, VA (Licence: AZ 4034) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 4034) | |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2015-11-02 |