Provider Demographics
NPI:1811013345
Name:INITIALCARE PLUS, PLLC
Entity Type:Organization
Organization Name:INITIALCARE PLUS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:URELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:406-761-6100
Mailing Address - Street 1:125 NORTHWEST BYP
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-4141
Mailing Address - Country:US
Mailing Address - Phone:406-761-6100
Mailing Address - Fax:406-761-6107
Practice Address - Street 1:125 NORTHWEST BYP
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-4141
Practice Address - Country:US
Practice Address - Phone:406-761-6100
Practice Address - Fax:406-761-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTE20715Medicare UPIN