Provider Demographics
NPI:1912212838
Name:GLACIER HEALTHCARE, LLC
Entity Type:Organization
Organization Name:GLACIER HEALTHCARE, LLC
Other - Org Name:ADVANCED SURGICAL HEALTHCARE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:EMERY
Authorized Official - Last Name:HUFFMYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-285-8900
Mailing Address - Street 1:416 W 15TH ST
Mailing Address - Street 2:BUILDING 400, SUITE B
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3747
Mailing Address - Country:US
Mailing Address - Phone:405-285-8900
Mailing Address - Fax:405-285-8921
Practice Address - Street 1:416 W. 15TH STREET
Practice Address - Street 2:BUILDING 400, SUITE B
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3688
Practice Address - Country:US
Practice Address - Phone:405-285-8900
Practice Address - Fax:405-285-8921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty