Provider Demographics
NPI:1205991494
Name:COUNTY OF MISSOULA
Entity type:Organization
Organization Name:COUNTY OF MISSOULA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-258-4996
Mailing Address - Street 1:301 W ALDER ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4123
Mailing Address - Country:US
Mailing Address - Phone:406-258-4750
Mailing Address - Fax:406-258-4913
Practice Address - Street 1:301 W ALDER ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4123
Practice Address - Country:US
Practice Address - Phone:406-258-4745
Practice Address - Fax:406-258-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000290485Medicaid
MT0000290030Medicaid
MT0000280534Medicaid
MT03124 8OtherBCBS OF MT
MT0003500978Medicaid
MT0000601579Medicaid
MT000003640Medicare PIN
MT0000290485Medicaid
MT600000292Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MT0000290030Medicaid