Provider Demographics
NPI:1346691144
Name:PRACTICE HEALTH PC
Entity Type:Organization
Organization Name:PRACTICE HEALTH PC
Other - Org Name:PRACTICE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-926-3000
Mailing Address - Street 1:825 W SPRUCE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3947
Mailing Address - Country:US
Mailing Address - Phone:406-926-3000
Mailing Address - Fax:406-926-3003
Practice Address - Street 1:825 W SPRUCE ST
Practice Address - Street 2:SUITE B
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3947
Practice Address - Country:US
Practice Address - Phone:406-926-3000
Practice Address - Fax:406-926-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT958CHI261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care