| Premise Health Of Montana Medical Pc | |
|
602 E Park Ave Anaconda MT 59711-2469 | |
| (406) 384-7630 | |
| (406) 384-7374 |
| Full Name | Premise Health Of Montana Medical Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 602 E Park Ave, Anaconda, Montana |
| Authorized Official Name and Position | Jonathan Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premise Health Of Montana Medical Pc 5500 Maryland Way Ste 120 Brentwood TN 37027-4993 Ph: () - | Premise Health Of Montana Medical Pc 602 E Park Ave Anaconda MT 59711-2469 Ph: (406) 384-7630 |
| NPI Number | 1093397978 |
|---|---|
| Provider Enumeration Date | 04/21/2021 |
| Last Update Date | 10/14/2024 |
| Medicare PECOS PAC ID | 7214460559 |
|---|---|
| Medicare Enrollment ID | O20241025000442 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093397978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Joseph M Gassenberg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558413252 PECOS PAC ID: 0244226116 Enrollment ID: I20040424000251 |
| Provider Name | Tracey Richardson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902099716 PECOS PAC ID: 3870649932 Enrollment ID: I20241104003440 |
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