Provider Demographics
NPI:1477375988
Name:HARVEST HEALTHCARE MT
Entity type:Organization
Organization Name:HARVEST HEALTHCARE MT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:406-403-4798
Mailing Address - Street 1:3400 9TH AVE S # 6742
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-9998
Mailing Address - Country:US
Mailing Address - Phone:406-403-4798
Mailing Address - Fax:406-743-1622
Practice Address - Street 1:1601 2ND AVE N STE 520
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3289
Practice Address - Country:US
Practice Address - Phone:406-403-4798
Practice Address - Fax:406-743-1622
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARVEST HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service