Provider Demographics
NPI:1285826826
Name:BIG SKY SPINAL CARE CENTER, INC.
Entity Type:Organization
Organization Name:BIG SKY SPINAL CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCEP
Authorized Official - Phone:406-388-9915
Mailing Address - Street 1:8757 JACKRABBIT LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-7900
Mailing Address - Country:US
Mailing Address - Phone:406-388-8118
Mailing Address - Fax:
Practice Address - Street 1:8757 JACKRABBIT LN
Practice Address - Street 2:SUITE B
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-7900
Practice Address - Country:US
Practice Address - Phone:406-388-8118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1085261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT41653OtherBCBS MT PIN