| NPI | 1740659952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE LIBERTINI Payer Enrollment Supervisor 406-414-1958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2025-10-24 |