Healthcare Provider Details

I. General information

NPI: 1104865120
Provider Name (Legal Business Name): GREAT FALLS ORTHOPAEDIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 25TH ST S
GREAT FALLS MT
59405-6306
US

IV. Provider business mailing address

PO BOX 6988 1401 25TH ST S
GREAT FALLS MT
59406-6988
US

V. Phone/Fax

Practice location:
  • Phone: 406-455-3650
  • Fax: 406-455-3695
Mailing address:
  • Phone: 406-455-3650
  • Fax: 406-455-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY S TIERNEY
Title or Position: CORPORATE VICE PRESIDENT
Credential: M.D.
Phone: 406-455-3650