| Ponderosa Medical Clinic | |
|
310 Spruce St Superior MT 59872-9680 | |
| (406) 822-4100 | |
| Not Available |
| Full Name | Ponderosa Medical Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 310 Spruce St, Superior, Montana |
| Authorized Official Name and Position | Terry Allen Smith (OWNER) |
| Authorized Official Contact | 4068224100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ponderosa Medical Clinic 310 Spruce St Po Box 340 Superior MT 59872-9680 Ph: (406) 822-4100 | Ponderosa Medical Clinic 310 Spruce St Superior MT 59872-9680 Ph: (406) 822-4100 |
| NPI Number | 1932395084 |
|---|---|
| Provider Enumeration Date | 09/22/2007 |
| Last Update Date | 10/18/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932395084 | NPI | - | NPPES |
| 97711 | Other | MT | BLUE CROSS BLUE SHIELD |
| 0066521 | Medicaid | MT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 7350 (Montana) | Primary |
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