Provider Demographics
NPI:1720167760
Name:GREAT FALLS ORTHOPEDIC ASSOCIATES
Entity Type:Organization
Organization Name:GREAT FALLS ORTHOPEDIC ASSOCIATES
Other - Org Name:HEIGHTS IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-455-3661
Mailing Address - Street 1:500 15TH AVE S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4324
Mailing Address - Country:US
Mailing Address - Phone:406-455-3650
Mailing Address - Fax:406-455-3695
Practice Address - Street 1:500 15TH AVE S
Practice Address - Street 2:SUITE 1
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4324
Practice Address - Country:US
Practice Address - Phone:406-455-3666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT16872471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1390OtherRAILROAD MEDICARE
CO1390OtherRAILROAD MEDICARE
=========OtherCHAMPUS
MT000008412Medicare PIN