| NPI | 1154032472 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DONALD KISHBAUGH Manager 406-224-2244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2023-07-27 |