Basic Information
| Provider Information | |||||||||
| NPI: | 1770778144 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORENCE FAMILY PRACTICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7638 | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598077638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062734932 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5549 OLD HWY 93 | ||||||||
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| City: | FLORENCE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598336545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062734923 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 12/04/2007 | ||||||||
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| AuthorizedOfficialLastName: | STEVENS | ||||||||
| AuthorizedOfficialFirstName: | JOYCE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | DIR OF ANCILLARY/SATELLITE SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4067215600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 363LP0200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.