Healthcare Provider Details

I. General information

NPI: 1033119722
Provider Name (Legal Business Name): KISMET BIG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 GRAND DR
BIGFORK MT
59911
US

IV. Provider business mailing address

1050 GRAND DR
BIGFORK MT
59911-3563
US

V. Phone/Fax

Practice location:
  • Phone: 406-837-5041
  • Fax:
Mailing address:
  • Phone: 406-837-5041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number9829
License Number StateMT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier312078
Identifier TypeMEDICAID
Identifier StateMT
Identifier Issuer

VIII. Authorized Official

Name: MICHAEL MOORE
Title or Position: CFO
Credential:
Phone: 605-642-7736