Healthcare Provider Details

I. General information

NPI: 1053882993
Provider Name (Legal Business Name): INDEPENDENT SUPPLY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 9TH AVE S
GREAT FALLS MT
59405-2659
US

IV. Provider business mailing address

1312 9TH AVE S
GREAT FALLS MT
59405-2659
US

V. Phone/Fax

Practice location:
  • Phone: 406-992-2296
  • Fax: 406-770-3107
Mailing address:
  • Phone: 406-992-2296
  • Fax: 406-770-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RICHARD MCDOWELL
Title or Position: PRESIDENT
Credential: ATP
Phone: 406-992-2296