NPIMap

Organization Active NPI

Partnership Health Center Inc

Doing business as PHC Creamery

  • Family Medicine Physician
  • Missoula, MT
National Provider Identifier
1326336454
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PARTNERSHIP HEALTH CENTER INC
Doing business as
PHC Creamery
Practice address
401 Railroad St W
Missoula, MT 59802-4109
Phone
(406) 258-4496
Fax
(406) 258-4180
NPI assigned
Jul 11, 2011
Last updated
Mar 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lara Salazar
Title
Executive Director
Phone
(406) 258-3360

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X
Family Medicine Physician 207Q00000X Primary
Federally Qualified Health Center (FQHC) 261QF0400X
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

401 Railroad St W
Missoula, MT 59802-4109

Mailing address

401 Railroad St W
Missoula, MT 59802-4178
Phone (406) 258-4496

Other identifiers 1

IdentifierTypeStateIssuer
1326336454MedicaidMT

Other names 1

  • PHC Creamery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051026000379 MT Part B Supplier - Clinic/Group Practice 6103843479 Receives reassigned benefits from 98 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Missoula, MT; Seeley Lake, MT; Superior, MT
O20110921000805 MT Part A Provider - Federally Qualified Health Center (FQHC) 6103843479 Practice locations: Missoula, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326336454. Details of each certification follow.

Federally qualified health center certification: CCN 271843

Legal name
PARTNERSHIP HEALTH CENTER INC
Doing business as
PHC CREAMERY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 22, 2011
Last certification
Sep 22, 2011
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1992 in MT
Enrollment address
401 Railroad W St
Missoula, MT 59802-4109

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
27D2015742Partnership Health Center / Creamery Building401 West Railroad Street, Missoula, MT 59802Provider-performed microscopyNov 2, 2026

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

625 E Pine St
Missoula, MT 59802
Phone (406) 552-6210

Ownership & related parties

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kathleen Walters Individual Corporate DirectorBoard VP Jul 1, 2013
Jaime Dixon Individual W-2 Managing Employee Jan 1, 2026
Bryan William Chalmers Individual Corporate OfficerCfo Dec 16, 2019
Mark Thane Individual Corporate DirectorBoard Member Oct 1, 2019
Patricia Kero Individual Corporate DirectorBoard Member Nov 1, 2021
Jeffrey Weist Individual Corporate DirectorBoard President Oct 1, 2006
Talbert Demeester Individual Corporate DirectorBoard Member Oct 1, 2018
Joseph Melvin Individual Corporate DirectorBoard Member Jan 1, 2019
Andrea Green Individual Corporate DirectorBoard Member Mar 1, 2021
Natalie Wolfram Individual Corporate DirectorBoard Member Oct 1, 2018
Holly Blaylock Individual W-2 Managing EmployeeRevenue Cycle Manager Jul 6, 2015
Karen Myers Individual Corporate DirectorBoard Member Sep 1, 2019
David Strohmaier Individual Corporate DirectorBoard Member Jul 1, 2019
John Crawford Individual Corporate DirectorBoard Treasurer Feb 1, 2016
Bruce W Richardson Individual Corporate DirectorBoard Member Oct 1, 2020
Jilayne Dunn Individual Corporate DirectorBoard Member Dec 1, 2013

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740960000000",
    "number": "1326336454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 RAILROAD ST W",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024178",
            "telephone_number": "406-258-4496",
            "fax_number": "406-258-4578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 RAILROAD ST W",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024109",
            "telephone_number": "406-258-4496",
            "fax_number": "406-258-4180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARTNERSHIP HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-11",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A",
        "authorized_official_last_name": "SALAZAR",
        "authorized_official_first_name": "LARA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "406-258-3360"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326336454",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHC Creamery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PHC Creamery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.