Provider Demographics
NPI:1801381934
Name:PARK HEALTH CARE PLLC
Entity Type:Organization
Organization Name:PARK HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NOTEBOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-224-8724
Mailing Address - Street 1:1001 RIVER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-3716
Mailing Address - Country:US
Mailing Address - Phone:406-624-6870
Mailing Address - Fax:
Practice Address - Street 1:1001 RIVER DR STE 100
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3716
Practice Address - Country:US
Practice Address - Phone:406-624-6870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-01
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty