Healthcare Provider Details

I. General information

NPI: 1154079366
Provider Name (Legal Business Name): BIG SKY LIFE SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 PHEASANT DR
MISSOULA MT
59808-1012
US

IV. Provider business mailing address

8420 PHEASANT DR
MISSOULA MT
59808-1012
US

V. Phone/Fax

Practice location:
  • Phone: 406-880-0184
  • Fax: 406-258-0512
Mailing address:
  • Phone: 406-880-0184
  • Fax: 406-258-0512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER PAUL BUCKLES
Title or Position: ADMINISTRATOR
Credential: HCA
Phone: 406-880-0184