| NPI | 1790870442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRIS M DALTON Clinic Manager 406-443-7733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 9893) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 9754) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MT 9754) | |
| 363AM0700X Physician Assistant, Medical (Licence: MT 469) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2011-12-20 |