Provider Demographics
NPI:1689973570
Name:T SHULL LEMIRE MD LLC
Entity Type:Organization
Organization Name:T SHULL LEMIRE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:SHULL
Authorized Official - Last Name:LEMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-721-8608
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-0656
Mailing Address - Country:US
Mailing Address - Phone:406-721-8608
Mailing Address - Fax:406-728-2322
Practice Address - Street 1:2825 FORT MISSOULA RD
Practice Address - Street 2:STE 317B
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7420
Practice Address - Country:US
Practice Address - Phone:406-721-8608
Practice Address - Fax:406-728-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6448207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E28047Medicare UPIN