Provider Demographics
NPI:1831802289
Name:BIG SKY FAMILY HEALTH CLINIC
Entity type:Organization
Organization Name:BIG SKY FAMILY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-792-6239
Mailing Address - Street 1:2210 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6068
Mailing Address - Country:US
Mailing Address - Phone:406-792-6239
Mailing Address - Fax:406-299-2448
Practice Address - Street 1:2210 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6068
Practice Address - Country:US
Practice Address - Phone:406-792-6239
Practice Address - Fax:406-299-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1427536242OtherINDIVIDUAL TYPE 1 NPI NUMBER