Provider Demographics
NPI:1467000554
Name:FOUR O SIX FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:FOUR O SIX FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:406-952-0061
Mailing Address - Street 1:2517 7TH AVE S STE B2
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3033
Mailing Address - Country:US
Mailing Address - Phone:406-952-0061
Mailing Address - Fax:406-952-0064
Practice Address - Street 1:2517 7TH AVE S STE B2
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3033
Practice Address - Country:US
Practice Address - Phone:406-952-0061
Practice Address - Fax:406-952-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-31
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty