Provider Demographics
NPI:1912235631
Name:HIGH PLAINS FAMILY HEALTH CARE
Entity Type:Organization
Organization Name:HIGH PLAINS FAMILY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHELT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP
Authorized Official - Phone:406-378-2508
Mailing Address - Street 1:88 JOHANNES AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BIG SANDY
Mailing Address - State:MT
Mailing Address - Zip Code:59520
Mailing Address - Country:US
Mailing Address - Phone:406-378-2508
Mailing Address - Fax:406-378-2508
Practice Address - Street 1:88 JOHANNES AVE STE A
Practice Address - Street 2:
Practice Address - City:BIG SANDY
Practice Address - State:MT
Practice Address - Zip Code:59520
Practice Address - Country:US
Practice Address - Phone:406-378-2508
Practice Address - Fax:406-378-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24903RN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4303890Medicaid
MT4303890Medicaid
MT000084134Medicare PIN