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: 08/27/2025
Certification Date: 08/27/2025
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: 406-247-7130
  • Fax:
Mailing address:
  • Phone: 406-315-2400
  • Fax: 406-315-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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