Provider Demographics
NPI:1083668651
Name:LEWIS AND CLARK EMERGENCY PHYSICIANS P C
Entity Type:Organization
Organization Name:LEWIS AND CLARK EMERGENCY PHYSICIANS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:COIL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:406-202-2283
Mailing Address - Street 1:PO BOX 864951
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-4951
Mailing Address - Country:US
Mailing Address - Phone:866-227-6164
Mailing Address - Fax:
Practice Address - Street 1:2475 E BROADWAY ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4928
Practice Address - Country:US
Practice Address - Phone:406-442-2480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1083668651Medicaid
MT187223500OtherUS DEPT OF LABOR
MTCE8304OtherRRMCR
MT187223500OtherUS DEPT OF LABOR