Ponderosa Medical Clinic | |
310 Spruce St Superior MT 59872-9680 | |
(406) 822-4100 | |
Not Available |
Full Name | Ponderosa Medical Clinic |
---|---|
Speciality | Clinic/center |
Location | 310 Spruce St, Superior, Montana |
Authorized Official Name and Position | Terry Allen Smith (OWNER) |
Authorized Official Contact | 4068224100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Ponderosa Medical Clinic 310 Spruce St Po Box 340 Superior MT 59872-9680 Ph: (406) 822-4100 | Ponderosa Medical Clinic 310 Spruce St Superior MT 59872-9680 Ph: (406) 822-4100 |
NPI Number | 1932395084 |
---|---|
Provider Enumeration Date | 09/22/2007 |
Last Update Date | 10/18/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932395084 | NPI | - | NPPES |
97711 | Other | MT | BLUE CROSS BLUE SHIELD |
0066521 | Medicaid | MT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 7350 (Montana) | Primary |
News Archive
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