Provider Demographics
NPI:1710171657
Name:COSTCARE, PLLC
Entity Type:Organization
Organization Name:COSTCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:VON ESCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:406-541-6900
Mailing Address - Street 1:2700 RADIO WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1385
Mailing Address - Country:US
Mailing Address - Phone:406-541-6900
Mailing Address - Fax:406-541-6901
Practice Address - Street 1:2700 RADIO WAY
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1385
Practice Address - Country:US
Practice Address - Phone:406-541-6900
Practice Address - Fax:406-541-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty