Provider Demographics
NPI:1992365951
Name:MISSOULA FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:MISSOULA FAMILY MEDICINE PLLC
Other - Org Name:MISSOULA FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-493-1600
Mailing Address - Street 1:4425 SUNDOWN RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7109
Mailing Address - Country:US
Mailing Address - Phone:406-370-2187
Mailing Address - Fax:
Practice Address - Street 1:2831 FORT MISSOULA RD STE 302
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7401
Practice Address - Country:US
Practice Address - Phone:406-493-1600
Practice Address - Fax:406-493-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty