| Phc Poverello | |
|
1110 W Broadway St Missoula MT 59802-3918 | |
| (406) 728-1809 | |
| (406) 258-4732 |
| Full Name | Phc Poverello |
|---|---|
| Speciality | Clinic/Center |
| Location | 1110 W Broadway St, Missoula, Montana |
| Authorized Official Name and Position | Laurie Francis (EXECURIVE DIRECTOR) |
| Authorized Official Contact | 4062583360 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phc Poverello 323 W Alder St Missoula MT 59802-4123 Ph: (406) 258-4789 | Phc Poverello 1110 W Broadway St Missoula MT 59802-3918 Ph: (406) 728-1809 |
| NPI Number | 1871881904 |
|---|---|
| Provider Enumeration Date | 07/11/2011 |
| Last Update Date | 12/16/2019 |
| Medicare PECOS PAC ID | 6103843479 |
|---|---|
| Medicare Enrollment ID | O20110922000309 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871881904 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
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