Healthcare Provider Details

I. General information

NPI: 1396349718
Provider Name (Legal Business Name): GLACIER MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 BAKER AVE
WHITEFISH MT
59937-2901
US

IV. Provider business mailing address

1111 BAKER AVE
WHITEFISH MT
59937-2901
US

V. Phone/Fax

Practice location:
  • Phone: 406-862-2515
  • Fax: 406-862-4229
Mailing address:
  • Phone: 406-862-2515
  • Fax: 406-862-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY MULCAHY
Title or Position: HR
Credential:
Phone: 406-863-4118