MEDICARE: GREAT FALLS CLINIC SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	9722	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	27C0001016	OTHER		CMS (FORMERLY HCFA)

General Provider Information

NPI Number	:	1447251327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT FALLS CLINIC SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	1509 29TH ST S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-5363
Country	:	US
Telephone Number	:	406-771-3500
Fax Number	:	406-771-3502

Provider Business Practice Location Address
First Line	:	1509 29TH ST S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-5363
Country	:	US
Telephone Number	:	406-771-3500
Fax Number	:	406-771-3501

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. CHERYL D CORNWELL
Credential	:
Telephone Number	:	406-216-8057

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/20/2011

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