Healthcare Provider Details

I. General information

NPI: 1295863017
Provider Name (Legal Business Name): MEDICAL CLINIC OF BIG SKY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BEAVERHEAD TRAIL
BIG SKY MT
59716-0609
US

IV. Provider business mailing address

PO BOX 160609
BIG SKY MT
59716-0609
US

V. Phone/Fax

Practice location:
  • Phone: 406-995-2797
  • Fax: 406-995-2965
Mailing address:
  • Phone: 406-995-2797
  • Fax: 406-995-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLA CATHERINE FRITZ
Title or Position: PARTNER
Credential: M.D.
Phone: 406-995-2797