Provider Demographics
NPI:1073142717
Name:TOMMIE L PERUSICH, PC
Entity Type:Organization
Organization Name:TOMMIE L PERUSICH, PC
Other - Org Name:TOMMIE L. PERUSICH, PMHNP-BC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER / BILLING
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-646-2470
Mailing Address - Street 1:84 OHIO ST
Mailing Address - Street 2:STE 5
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1806
Mailing Address - Country:US
Mailing Address - Phone:406-646-2470
Mailing Address - Fax:406-299-3911
Practice Address - Street 1:84 OHIO ST
Practice Address - Street 2:STE 5
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1806
Practice Address - Country:US
Practice Address - Phone:406-646-2470
Practice Address - Fax:406-299-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-04
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty