Provider Demographics
NPI:1346984101
Name:FIRST MED LLC
Entity type:Organization
Organization Name:FIRST MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:KINGSBURY
Authorized Official - Last Name:MILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:406-241-0233
Mailing Address - Street 1:4540 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-6110
Mailing Address - Country:US
Mailing Address - Phone:406-241-0233
Mailing Address - Fax:
Practice Address - Street 1:2330 S HIGGINS AVE STE 200
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6923
Practice Address - Country:US
Practice Address - Phone:406-728-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care