Provider Demographics
NPI:1407300619
Name:BIG SKY FOOT & ANKLE INSTITUTE, INC
Entity Type:Organization
Organization Name:BIG SKY FOOT & ANKLE INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO- PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:602-882-6322
Mailing Address - Street 1:PO BOX 19379
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4088
Mailing Address - Country:US
Mailing Address - Phone:406-782-2278
Mailing Address - Fax:406-782-2278
Practice Address - Street 1:401 S ALABAMA ST STE 10
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2358
Practice Address - Country:US
Practice Address - Phone:406-782-2278
Practice Address - Fax:406-782-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT44408213ES0103X
MT44493213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7576050001Medicare NSC