Healthcare Provider Details

I. General information

NPI: 1639158645
Provider Name (Legal Business Name): BIG SKY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 FORT MISSOULA RD
MISSOULA MT
59804-7408
US

IV. Provider business mailing address

2833 FORT MISSOULA RD
MISSOULA MT
59804-7408
US

V. Phone/Fax

Practice location:
  • Phone: 406-542-6559
  • Fax: 406-542-9040
Mailing address:
  • Phone: 406-542-6559
  • Fax: 406-542-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number10470
License Number StateMT

VIII. Authorized Official

Name: DR. DANIEL BRABY
Title or Position: PRESIDENT
Credential: MD
Phone: 406-541-3277