Healthcare Provider Details

I. General information

NPI: 1699413369
Provider Name (Legal Business Name): LITTLE SHELL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SMELTER AVE NE
GREAT FALLS MT
59404-1927
US

IV. Provider business mailing address

425 SMELTER AVE NE
GREAT FALLS MT
59404-1927
US

V. Phone/Fax

Practice location:
  • Phone: 406-247-7130
  • Fax:
Mailing address:
  • Phone: 406-247-7130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: STACEY L. THOMAS
Title or Position: ACTING CHIEF EXECUTIVE OFFICER
Credential:
Phone: 406-247-7130