Healthcare Provider Details

I. General information

NPI: 1447251327
Provider Name (Legal Business Name): GREAT FALLS CLINIC SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 29TH ST S
GREAT FALLS MT
59405-5363
US

IV. Provider business mailing address

1509 29TH ST S
GREAT FALLS MT
59405-5363
US

V. Phone/Fax

Practice location:
  • Phone: 406-771-3500
  • Fax: 406-771-3501
Mailing address:
  • Phone: 406-771-3500
  • Fax: 406-771-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number9722
License Number StateMT

VIII. Authorized Official

Name: MR. CHERYL D CORNWELL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 406-216-8057