Provider Demographics
NPI:1083727374
Name:BITTERROOT FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:BITTERROOT FAMILY MEDICINE, P.C.
Other - Org Name:FAMILY MEDICINE CENTER OF THE BITTERROOT, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-363-3627
Mailing Address - Street 1:330 N 10TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2319
Mailing Address - Country:US
Mailing Address - Phone:406-363-3627
Mailing Address - Fax:406-363-3638
Practice Address - Street 1:330 N 10TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2319
Practice Address - Country:US
Practice Address - Phone:406-363-3627
Practice Address - Fax:406-363-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT27D1025693OtherCLIA #
MT9970670Medicaid
MT000083932Medicare ID - Type UnspecifiedMT GROUP MEDICARE I.D.