Provider Demographics
NPI:1477640605
Name:FAMILY MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT OF MABCO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-495-7220
Mailing Address - Street 1:PO BOX 5179
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-5179
Mailing Address - Country:US
Mailing Address - Phone:406-495-7269
Mailing Address - Fax:406-443-4526
Practice Address - Street 1:100 N OAK ST
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:MT
Practice Address - Zip Code:59644-2306
Practice Address - Country:US
Practice Address - Phone:406-266-5204
Practice Address - Fax:406-266-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTDB2795OtherRAILROAD MEDICARE