Provider Demographics
NPI:1609001338
Name:PREMIER FAMILY PRACTICE, P.C.
Entity Type:Organization
Organization Name:PREMIER FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-846-7770
Mailing Address - Street 1:600 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-1440
Mailing Address - Country:US
Mailing Address - Phone:406-846-7770
Mailing Address - Fax:406-846-7771
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-1440
Practice Address - Country:US
Practice Address - Phone:406-846-7770
Practice Address - Fax:406-846-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty