Basic Information
| Provider Information | |||||||||
| NPI: | 1265477913 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEELEY SWAN MEDICAL CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7666 | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598077666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067215600 | ||||||||
| FaxNumber: | 4067213907 | ||||||||
| Practice Location | |||||||||
| Address1: | 3050 MT HIGHWAY 83 N | ||||||||
| Address2: | |||||||||
| City: | SEELEY LAKE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598681380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066772277 | ||||||||
| FaxNumber: | 4066772387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 01/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | STEVENS | ||||||||
| AuthorizedOfficialFirstName: | JYOCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIR OF ANCILLARY & SATELLITE SVS | ||||||||
| AuthorizedOfficialTelephone: | 4067215600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11319 | MT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.