Provider Demographics
NPI:1104865120
Name:GREAT FALLS ORTHOPAEDIC ASSOCIATES
Entity Type:Organization
Organization Name:GREAT FALLS ORTHOPAEDIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TIERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-455-3650
Mailing Address - Street 1:PO BOX 6988
Mailing Address - Street 2:1401 25TH ST S
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-6988
Mailing Address - Country:US
Mailing Address - Phone:406-455-3650
Mailing Address - Fax:406-455-3695
Practice Address - Street 1:1401 25TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-6306
Practice Address - Country:US
Practice Address - Phone:406-455-3650
Practice Address - Fax:406-455-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTC01390OtherRAILROAD MEDICARE
MT0027504OtherWASHINGTON L &
MT0027504OtherWASHINGTON L &
MTC01390OtherRAILROAD MEDICARE
MT000008412Medicare PIN