NPIMap

Organization Active NPI

Missoula Osteopathic Clinic, PLLC

  • Neuromusculoskeletal Medicine & OMM Physician
  • Missoula, MT
National Provider Identifier
1912133885
Registry record updated Jun 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X
License
8667 Issued in MT
Legal business name
MISSOULA OSTEOPATHIC CLINIC, PLLC
Practice address
341 W Pine St
Missoula, MT 59802-4119
Phone
(406) 327-0269
Fax
(406) 327-0264
NPI assigned
Jun 5, 2009
Last updated
Jun 5, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2009

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

Authorized official

Name
Sam A Wallace, D.O.NPI 1144353707
Title
Owner/Physician
Phone
(406) 327-0269

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromusculoskeletal Medicine & OMM Physician 204D00000X 11754 MT
Neuromusculoskeletal Medicine & OMM Physician 204D00000X 11801 MT
Neuromusculoskeletal Medicine & OMM Physician 204D00000X 8667 MT Primary

Addresses

Primary practice location

341 W Pine St
Missoula, MT 59802-4119

Mailing address

341 W Pine St
Missoula, MT 59802-4119
Phone (406) 327-0269

National Provider Directory

National Provider Directory
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.

Locations

341 W Pine St
Missoula, MT 59802
Phone (406) 327-0269

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1244160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244160000000",
    "number": "1912133885",
    "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, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-05",
        "last_updated": "2009-06-05",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "406-327-0269",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "MT",
            "license": "11754",
            "primary": false
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "MT",
            "license": "11801",
            "primary": false
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "MT",
            "license": "8667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2009; 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.