Provider Demographics
NPI:1225381205
Name:MISSOULA VALLEY MEDICAL
Entity type:Organization
Organization Name:MISSOULA VALLEY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-251-9343
Mailing Address - Street 1:3295 CATHY CT
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803
Mailing Address - Country:US
Mailing Address - Phone:406-251-9343
Mailing Address - Fax:406-251-7255
Practice Address - Street 1:3295 CATHY CT
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803
Practice Address - Country:US
Practice Address - Phone:406-251-9343
Practice Address - Fax:406-251-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies