| Montana Skin & Laser And Center For Weight Management | |
|
1415 Northwest Byp Ste 2 Great Falls MT 59404-1710 | |
| (406) 788-6300 | |
| Not Available |
| Full Name | Montana Skin & Laser And Center For Weight Management |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1415 Northwest Byp Ste 2, Great Falls, Montana |
| Authorized Official Name and Position | Jacqueline Cooke (OWNER) |
| Authorized Official Contact | 4067886300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Montana Skin & Laser And Center For Weight Management 1415 Northwest Byp Ste 2 Great Falls MT 59404-1710 Ph: (406) 788-6300 | Montana Skin & Laser And Center For Weight Management 1415 Northwest Byp Ste 2 Great Falls MT 59404-1710 Ph: (406) 788-6300 |
| NPI Number | 1669187563 |
|---|---|
| Provider Enumeration Date | 01/16/2023 |
| Last Update Date | 04/21/2023 |
| Medicare PECOS PAC ID | 6507225943 |
|---|---|
| Medicare Enrollment ID | O20230703003046 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669187563 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Sarah Monzella Pack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841853876 PECOS PAC ID: 9537550421 Enrollment ID: I20220104001351 |
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