Provider Demographics
NPI:1013119171
Name:PLAINS SYNERGY HEALTHCARE PLLC
Entity Type:Organization
Organization Name:PLAINS SYNERGY HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-377-1179
Mailing Address - Street 1:100 1/2 S. MERRILL AVE.
Mailing Address - Street 2:SUITE #24
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330
Mailing Address - Country:US
Mailing Address - Phone:406-377-1179
Mailing Address - Fax:
Practice Address - Street 1:100 S MERRILL AVE
Practice Address - Street 2:SUITE #24
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-1635
Practice Address - Country:US
Practice Address - Phone:406-377-1179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9958207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty