| Kristina M. Miner | |
|
1600 North Ave W Ste 106 Missoula MT 59801-5500 | |
| (406) 544-7678 | |
| (406) 926-3117 |
| Full Name | Kristina M. Miner |
|---|---|
| Speciality | Clinic/Center |
| Location | 1600 North Ave W Ste 106, Missoula, Montana |
| Authorized Official Name and Position | Kristina Marie Miner (SOLE MEMBER) |
| Authorized Official Contact | 4065447678 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kristina M. Miner 1600 North Ave W Ste 106 Missoula MT 59801-5500 Ph: (406) 544-7678 | Kristina M. Miner 1600 North Ave W Ste 106 Missoula MT 59801-5500 Ph: (406) 544-7678 |
| NPI Number | 1871953976 |
|---|---|
| Provider Enumeration Date | 03/02/2016 |
| Last Update Date | 01/21/2019 |
| Medicare PECOS PAC ID | 2365709862 |
|---|---|
| Medicare Enrollment ID | O20171207001873 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871953976 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 999 (Montana) | Primary |
| Provider Name | Kristina M Miner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538473004 PECOS PAC ID: 7416133756 Enrollment ID: I20110520000321 |
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