| Organization Name: | COMMUNITY MEDICAL SERVICES III, LLC PRIVATE |
| NPI Number: | 1023484615 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDY G LEWIS (CFO) |
| Mailing Address: | 2415 S Catlin St Missoula |
| State: | MT US |
| Postal Code: | 598017822 |
| Phone Number: | 4065490114 |
| Fax Number: | 4065490267 |
| NPI Enumeration Date: | 08/18/2015 |
| NPI Last Update Date: | 08/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM2800X |
| License Number: | MT10001M |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Methadone Clinic |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |