Provider Demographics
NPI:1790755445
Name:JANE C WELLS MD MHS PLLC
Entity Type:Organization
Organization Name:JANE C WELLS MD MHS PLLC
Other - Org Name:JANE C WELLS MD MHS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MS MHA
Authorized Official - Phone:406-541-6220
Mailing Address - Street 1:700 SOUTH AVENUE WEST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801
Mailing Address - Country:US
Mailing Address - Phone:406-541-6220
Mailing Address - Fax:406-541-6221
Practice Address - Street 1:700 SOUTH AVENUE WEST
Practice Address - Street 2:SUITE B
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-541-6220
Practice Address - Fax:406-541-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT96762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D76835Medicare UPIN