Provider Demographics
NPI:1144683475
Name:CENTRAL MEDISPA LLC
Entity type:Organization
Organization Name:CENTRAL MEDISPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNP
Authorized Official - Phone:406-488-5000
Mailing Address - Street 1:309 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-4127
Mailing Address - Country:US
Mailing Address - Phone:406-488-5000
Mailing Address - Fax:844-766-1639
Practice Address - Street 1:309 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-4127
Practice Address - Country:US
Practice Address - Phone:406-488-5000
Practice Address - Fax:844-766-1639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESPRIT HEALTH & WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-04
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR APRN LIC 100657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty