Healthcare Provider Details

I. General information

NPI: 1083110498
Provider Name (Legal Business Name): CAIRN MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 HIGHWAY 35, SUITE 210
BIGFORK MT
59911
US

IV. Provider business mailing address

8111 HIGHWAY 35, SUITE 210
BIGFORK MT
59911
US

V. Phone/Fax

Practice location:
  • Phone: 406-300-4712
  • Fax: 406-420-5050
Mailing address:
  • Phone: 406-300-4712
  • Fax: 406-420-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12202
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number12202
License Number StateMT

VIII. Authorized Official

Name: DR. GREG VANICHKACHORN
Title or Position: PRESIDENT
Credential: MD, MPH
Phone: 406-300-4712