Provider Demographics
NPI:1063083418
Name:BIOME GROUP HEALTH, PLLC
Entity type:Organization
Organization Name:BIOME GROUP HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:CAVALIER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:480-628-3002
Mailing Address - Street 1:PO BOX 9352
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-9352
Mailing Address - Country:US
Mailing Address - Phone:406-544-6214
Mailing Address - Fax:
Practice Address - Street 1:2831 FORT MISSOULA RD. BLDG. 2
Practice Address - Street 2:STE. 203
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7479
Practice Address - Country:US
Practice Address - Phone:480-628-3002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care