# MALTA MEDICAL ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Malta Medical Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528716370
- **Authorized official:** DR. EDWIN MEDINA MD (PRESIDENT/CHIEF MEDICAL OFFICER)
- **Authorized official phone:** (406) 654-2878

## Contact information

- **Practice address:** 801 S 3RD ST E RM 304, MALTA, MT 59538-8769
- **Practice address phone:** (406) 654-2878
- **Practice address fax:** (406) 654-2810
- **Mailing address:** PO BOX 1235, MALTA, MT 59538-1235
- **Mailing address phone:** (406) 654-2878
- **Mailing address fax:** (406) 654-2018

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/11/2022
- **Last updated:** 04/03/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0000922611 | BLUE CROSS BLUE SHIELD | MT |
| 05 | — | 0028223 | — | MT |
| 05 | — | 0720001 | — | MT |
| 05 | — | G414566 | — | MT |