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General NPI Number Information
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NPI Number | 1083420277
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Entity Type | Organization
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Legal Business Name | BAIREFOOT ENTERPRISES LLC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 34 APPLEWAY DR APT 1
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City | KALISPELL
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State | MT
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Zip | 59901-1608
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Country | US
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Telephone | 406-309-1542
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Fax |
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Provider Business Mailing Address
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Address Line | 34 APPLEWAY DR APT 1
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City | KALISPELL
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State | MT
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Zip | 59901-1608
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Country | US
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Telephone | 406-309-1542
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAWN EDWARD BAIREFOOT
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Credential |
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Telephone | 406-309-1542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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