| NPI | 1134304926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNY PANNELL Vice President 406-889-5577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 178.005206) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: IL 178.005206) |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2007-12-31 |