Healthcare Provider Details

I. General information

NPI: 1124013719
Provider Name (Legal Business Name): WHITEHALL MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W 1ST ST
WHITEHALL MT
59759-0339
US

IV. Provider business mailing address

PO BOX 339 108 FIRST ST W
WHITEHALL MT
59759-0339
US

V. Phone/Fax

Practice location:
  • Phone: 406-287-3003
  • Fax: 406-287-3014
Mailing address:
  • Phone: 406-287-3003
  • Fax: 406-287-3014

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: GAYLE FAYE SACRY
Title or Position: GENERAL PARTNER
Credential: M.D.
Phone: 406-287-3003