Healthcare Provider Details

I. General information

NPI: 1649970526
Provider Name (Legal Business Name): LITTLE SHELL TRIBE OF CHIPPEWA INDIANS OF MONTANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 02/08/2026
Certification Date: 02/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SMELTER AVE NE
GREAT FALLS MT
59404-1927
US

IV. Provider business mailing address

511 CENTRAL AVE W
GREAT FALLS MT
59404-2848
US

V. Phone/Fax

Practice location:
  • Phone: 406-760-2055
  • Fax: 406-403-0276
Mailing address:
  • Phone: 406-760-2055
  • Fax: 406-403-0276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GERALD GRAY JR.
Title or Position: CHAIRMAN
Credential:
Phone: 406-315-2400