Provider Demographics
NPI:1336319052
Name:BIG SKY FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:BIG SKY FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:L
Authorized Official - Last Name:TREPTOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-761-3556
Mailing Address - Street 1:2800 11TH AVE S
Mailing Address - Street 2:SUITE #12
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5263
Mailing Address - Country:US
Mailing Address - Phone:406-761-3556
Mailing Address - Fax:406-727-3910
Practice Address - Street 1:2800 11TH AVE S
Practice Address - Street 2:SUITE #12
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5263
Practice Address - Country:US
Practice Address - Phone:406-761-3556
Practice Address - Fax:406-727-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0037791Medicaid
MT000008407Medicare PIN
MT0037791Medicaid