Provider Demographics
NPI:1205837762
Name:PAINTER, GINA M (DPM)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:PAINTER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 11TH AVE S STE 6
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4654
Mailing Address - Country:US
Mailing Address - Phone:406-761-2222
Mailing Address - Fax:406-455-3695
Practice Address - Street 1:1401 25TH ST. SOUTH
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-455-3650
Practice Address - Fax:406-455-3695
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT138213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0390218Medicaid
000080797Medicare PIN
MT0390218Medicaid