Provider Demographics
NPI:1881849438
Name:TROOP FAMILY MEDICINE
Entity Type:Organization
Organization Name:TROOP FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TROOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-366-0148
Mailing Address - Street 1:PO BOX 738
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-0738
Mailing Address - Country:US
Mailing Address - Phone:406-366-0148
Mailing Address - Fax:
Practice Address - Street 1:310 WENDELL AVE
Practice Address - Street 2:5368 SANDHILL ROAD
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2267
Practice Address - Country:US
Practice Address - Phone:406-366-0148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000009774Medicare PIN
MTDA5184Medicare PIN