Provider Demographics
NPI:1598069429
Name:PRANA FAMILY PRACTICE
Entity Type:Organization
Organization Name:PRANA FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:OPPER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:406-240-0604
Mailing Address - Street 1:825 W KENT AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6619
Mailing Address - Country:US
Mailing Address - Phone:406-240-0604
Mailing Address - Fax:406-721-0055
Practice Address - Street 1:825 W KENT AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6619
Practice Address - Country:US
Practice Address - Phone:406-240-0604
Practice Address - Fax:406-721-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT37261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PO1127Medicare UPIN