Provider Demographics
NPI:1285935924
Name:CENTER FOR FAMILY HEALTH, LLC
Entity type:Organization
Organization Name:CENTER FOR FAMILY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:CODA
Authorized Official - Middle Name:E
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:406-723-0123
Mailing Address - Street 1:834 S MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2836
Mailing Address - Country:US
Mailing Address - Phone:406-723-0123
Mailing Address - Fax:406-723-0211
Practice Address - Street 1:834 S MONTANA ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2836
Practice Address - Country:US
Practice Address - Phone:406-723-0123
Practice Address - Fax:406-723-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7628305R00000X
MT33467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty