Main Street Medical | |
907 Main Street Thompson Falls MT 59873-0969 | |
(406) 827-4307 | |
Not Available |
Full Name | Main Street Medical |
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Speciality | Nurse Practitioner |
Location | 907 Main Street, Thompson Falls, Montana |
Authorized Official Name and Position | Wanda K Larsen (OFFICE MANAGER) |
Authorized Official Contact | 4068274307 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Main Street Medical Po Box 969 Thompson Falls MT 59873-0969 Ph: (406) 827-4307 | Main Street Medical 907 Main Street Thompson Falls MT 59873-0969 Ph: (406) 827-4307 |
NPI Number | 1447314174 |
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Provider Enumeration Date | 12/20/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 2769479823 |
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Medicare Enrollment ID | O20040429000752 |
Identifier | Type | State | Issuer |
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1447314174 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 6022 (Montana) | Primary |
363L00000X | Nurse Practitioner | 439 (Montana) | Primary |
Provider Name | Randy J Lovell |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1003836313 PECOS PAC ID: 5799682282 Enrollment ID: I20031213000048 |
Main Street Medical Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 907 Main Street, Thompson Falls, MT 59873 Phone: 406-827-4307 Fax: 406-827-9514 |