Provider Demographics
NPI:1013172675
Name:RANDY J. LOVELL, DO, PC
Entity Type:Organization
Organization Name:RANDY J. LOVELL, DO, PC
Other - Org Name:MAIN STREET MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-827-4307
Mailing Address - Street 1:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-0969
Mailing Address - Country:US
Mailing Address - Phone:406-827-4307
Mailing Address - Fax:406-827-9514
Practice Address - Street 1:907 MAIN STREET
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873-0969
Practice Address - Country:US
Practice Address - Phone:406-827-4307
Practice Address - Fax:406-827-9514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT273828Medicare PIN