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General NPI Number Information
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NPI Number | 1164473088
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Entity Type | Organization
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Legal Business Name | BIG SKY MEDICINE PC
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | 1520 EVERGREEN PKWY
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City | EVERGREEN
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State | CO
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Zip | 80439-7848
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Country | US
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Telephone | 303-674-2273
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Fax | 303-670-2160
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Provider Business Mailing Address
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Address Line | PO BOX 1926
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City | EVERGREEN
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State | CO
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Zip | 80437-1926
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Country | US
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Telephone | 303-674-2273
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Fax | 303-670-2160
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MARY SULLI
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Credential |
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Telephone | 303-674-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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