Provider Demographics
NPI:1922698737
Name:DOWNTOWN HEALTH CARE CLINIC, INC.
Entity Type:Organization
Organization Name:DOWNTOWN HEALTH CARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP, FNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, FNP-BC
Authorized Official - Phone:406-363-7003
Mailing Address - Street 1:PO BOX 1437
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-1437
Mailing Address - Country:US
Mailing Address - Phone:406-363-7003
Mailing Address - Fax:406-363-7001
Practice Address - Street 1:106 S 2ND ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2517
Practice Address - Country:US
Practice Address - Phone:406-210-7284
Practice Address - Fax:406-363-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty