Provider Demographics
NPI:1821320508
Name:HIGH PLAINS FAMILY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:HIGH PLAINS FAMILY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:REICHELT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:406-378-2508
Mailing Address - Street 1:88 JOHANNES AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BIG SANDY
Mailing Address - State:MT
Mailing Address - Zip Code:59520
Mailing Address - Country:US
Mailing Address - Phone:406-378-2508
Mailing Address - Fax:406-378-2509
Practice Address - Street 1:88 JOHANNES AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BIG SANDY
Practice Address - State:MT
Practice Address - Zip Code:59520
Practice Address - Country:US
Practice Address - Phone:406-378-2508
Practice Address - Fax:406-378-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24903364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4303890Medicaid
MTQ12575Medicare UPIN