| Wholly Authentic Life Llc | |
|
201 1st Ave N Fairfield MT 59436-9245 | |
| (406) 799-2711 | |
| (406) 467-3407 |
| Full Name | Wholly Authentic Life Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 201 1st Ave N, Fairfield, Montana |
| Authorized Official Name and Position | Tammie S Smith (MBR) |
| Authorized Official Contact | 4067992711 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wholly Authentic Life Llc Po Box 907 Fairfield MT 59436-0907 Ph: (406) 799-2711 | Wholly Authentic Life Llc 201 1st Ave N Fairfield MT 59436-9245 Ph: (406) 799-2711 |
| NPI Number | 1043930993 |
|---|---|
| Provider Enumeration Date | 08/31/2022 |
| Last Update Date | 09/29/2023 |
| Medicare PECOS PAC ID | 6103263363 |
|---|---|
| Medicare Enrollment ID | O20240322003353 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043930993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Tammie S Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780257717 PECOS PAC ID: 5092152264 Enrollment ID: I20240416003838 |
Fairfield Medical Clinic Llp Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 223 W Main, Fairfield, MT 59436 Phone: 406-467-2600 Fax: 406-467-3210 |