1285826826 NPI number — BIG SKY SPINAL CARE CENTER, INC.

Table of content: (NPI 1285826826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285826826 NPI number — BIG SKY SPINAL CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIG SKY SPINAL CARE CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285826826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8757 JACKRABBIT LN
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BELGRADE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59714-7900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-388-8118
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8757 JACKRABBIT LN
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BELGRADE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59714-7900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-388-8118
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILHELM
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
406-388-9915

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  1085 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41653 . This is a "BCBS MT PIN" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".