Provider Demographics
NPI:1205284999
Name:GREEN FLAG, PC
Entity type:Organization
Organization Name:GREEN FLAG, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTKOWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-640-4292
Mailing Address - Street 1:24 S WILLSON AVE
Mailing Address - Street 2:STE 10
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4665
Mailing Address - Country:US
Mailing Address - Phone:406-640-4292
Mailing Address - Fax:
Practice Address - Street 1:24 S WILLSON AVE
Practice Address - Street 2:STE 10
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4665
Practice Address - Country:US
Practice Address - Phone:406-640-4292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4673261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health