Provider Demographics
NPI:1811647563
Name:GREAT FALLS CONSULTING LLC
Entity type:Organization
Organization Name:GREAT FALLS CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-899-9561
Mailing Address - Street 1:503 CHESTER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:SC
Mailing Address - Zip Code:29055-1207
Mailing Address - Country:US
Mailing Address - Phone:803-482-7545
Mailing Address - Fax:
Practice Address - Street 1:503 CHESTER AVE STE A
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:SC
Practice Address - Zip Code:29055-1207
Practice Address - Country:US
Practice Address - Phone:803-482-7545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty