# MOCCASIN MOUNTAIN HEALTH CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053158766
- **Authorized official:** RANDI RATH PA (CEO)
- **Authorized official phone:** (406) 321-2431

## Contact information

- **Practice address:** 629 NE MAIN ST STE 2, LEWISTOWN, MT 59457-2082
- **Practice address phone:** (406) 321-2431
- **Mailing address:** 920 6TH AVE N, LEWISTOWN, MT 59457-2125
- **Mailing address phone:** (406) 321-2431

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/10/2024
- **Last updated:** 07/10/2024