Missoula Osteopathic Clinic, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MED-PHYS-LIC-8667 Issued in MT

Legal business name

MISSOULA OSTEOPATHIC CLINIC, LLC

Practice address

341 W Pine St
Missoula, MT 59802-4119

Phone

(406) 327-0269

Fax

(406) 327-0264

NPI assigned

Jun 21, 2013

Organization subpart

No

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

Authorized official

Name

Sam Aron Wallace, D.O.NPI 1144353707

Title

Owner/Physician

Phone

(406) 327-0269

Specialties & licenses 1

Addresses

Tax ID family

Missoula Osteopathic Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Missoula Osteopathic Clinic, PLLC

  • Neuromusculoskeletal Medicine & OMM Physician
  • Missoula, MT
  • NPI 1912133885
  NPD tax ID

Practitioners 1

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.

• Sam A Wallace, D.O.

  • Family Medicine Physician
  • Missoula, MT
  • NPI 1144353707
  NPD (past) Authorized official

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668038400000",
    "number": "1326487430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "341 W PINE ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024119",
            "telephone_number": "406-327-0269",
            "fax_number": "406-327-0264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341 W PINE ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024119",
            "telephone_number": "406-327-0269",
            "fax_number": "406-327-0264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOULA OSTEOPATHIC CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-21",
        "last_updated": "2022-11-10",
        "certification_date": "2022-10-26",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "ARON",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "406-327-0269",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "MED-PHYS-LIC-8667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Missoula Interfaith Collaborative
• Missoula OB-GYN Associates
• Missoula Obstetrics & Gynecology Specialists
• Missoula Oral Surgery
• Missoula Orthotics & Prosthetics Laboratory, Inc (Hanger Clinic)
• Missoula Osteopathic Clinic, PLLC
• Missoula Pediatric Dentistry PC
• Missoula Pediatric Dentistry, PLLC
• Missoula Pediatric Therapy Center Inc (Kidzoola Therapy Center)
• Missoula Peditric Dentistry, P.C.

• Family Medicine Physician in Missoula, MT
• Providers in Missoula, MT by specialty
• Family Medicine Physician in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.