Provider Demographics
NPI:1003030818
Name:TIM WEILL MD PC
Entity type:Organization
Organization Name:TIM WEILL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:WEILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-761-6880
Mailing Address - Street 1:2800 11TH AVE S
Mailing Address - Street 2:SUITE 13
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5263
Mailing Address - Country:US
Mailing Address - Phone:406-761-6880
Mailing Address - Fax:
Practice Address - Street 1:2800 11TH AVE S
Practice Address - Street 2:SUITE 13
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5263
Practice Address - Country:US
Practice Address - Phone:406-761-6880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0065739Medicaid
MT0065739Medicaid