27D2059725 CLIA NUMBER - PREMISE HEALTH OF MONTANA MEDICAL, PC

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Laboratory Demographics

CLIA Number: 27D2059725

Facility Name: PREMISE HEALTH OF MONTANA MEDICAL, PC

Facility Address:
1501 14TH STREET WEST, SUITE 230
BILLINGS, MT
ZIP 59102
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Facility Phone Number: 406 969-5116

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1386235794

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	27D2059725
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF MONTANA MEDICAL, PC
Street	1501 14TH STREET WEST, SUITE 230
City	BILLINGS
State	MT
ZIP	59102
Phone	406 969-5116
CertificateType	4
CertificateEffectiveDate	5/29/2023
CertificateExpirationDate	5/28/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024