Provider Demographics
NPI:1245788223
Name:CAPITAL CITY NATURAL MEDICINE
Entity Type:Organization
Organization Name:CAPITAL CITY NATURAL MEDICINE
Other - Org Name:NATURAL MEDICINE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROUSH
Authorized Official - Suffix:
Authorized Official - Credentials:NATUROPATH
Authorized Official - Phone:406-442-8508
Mailing Address - Street 1:33 NEILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MONTANA
Mailing Address - Zip Code:59601
Mailing Address - Country:UM
Mailing Address - Phone:406-442-8508
Mailing Address - Fax:406-442-2656
Practice Address - Street 1:33 NEILL AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3330
Practice Address - Country:US
Practice Address - Phone:406-442-8508
Practice Address - Fax:406-442-2656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAHC-NAT-LIC-99175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty