| Pure Infusion Suites Of Montana Llc | |
|
100 Brookshire Blvd Unit 1 Billings MT 59102-6751 | |
| (406) 702-1327 | |
| (406) 206-0105 |
| Full Name | Pure Infusion Suites Of Montana Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 100 Brookshire Blvd Unit 1, Billings, Montana |
| Authorized Official Name and Position | Rachel Fraga (CONTRACTING MANAGER) |
| Authorized Official Contact | 8019216325 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pure Infusion Suites Of Montana Llc 4179 S Riverboat Rd Ste 220 Taylorsville UT 84123-2986 Ph: (801) 755-3387 | Pure Infusion Suites Of Montana Llc 100 Brookshire Blvd Unit 1 Billings MT 59102-6751 Ph: (406) 702-1327 |
| NPI Number | 1588137228 |
|---|---|
| Provider Enumeration Date | 01/04/2019 |
| Last Update Date | 03/17/2023 |
| Medicare PECOS PAC ID | 6608119607 |
|---|---|
| Medicare Enrollment ID | O20190514003064 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588137228 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Horng-chyi R Lai |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1528385598 PECOS PAC ID: 9133437817 Enrollment ID: I20150929002795 |
| Provider Name | Stacey L Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154951192 PECOS PAC ID: 1557797628 Enrollment ID: I20200208000182 |
| Provider Name | Sadra Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528725637 PECOS PAC ID: 7315338621 Enrollment ID: I20211221002230 |
| Provider Name | Bowen Austin Stephen Trystianson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720604929 PECOS PAC ID: 1951778919 Enrollment ID: I20221103001232 |
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