Provider Demographics
NPI:1437337706
Name:GREAT FALLS ENT
Entity Type:Organization
Organization Name:GREAT FALLS ENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTUIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HAYTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-455-4470
Mailing Address - Street 1:2519 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5178
Mailing Address - Country:US
Mailing Address - Phone:406-455-4470
Mailing Address - Fax:406-168-0084
Practice Address - Street 1:400 13TH AVE S
Practice Address - Street 2:SUITE 105
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4300
Practice Address - Country:US
Practice Address - Phone:406-455-4470
Practice Address - Fax:406-268-0084
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEFIS HEALTHCARE PRACTITIONERS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11637207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty