=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215024435
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOUSE CALLS PRIMARY HEALTHCARE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2006
-----------------------------------------------------
Last Update Date | 10/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 9TH AVE S UNIT 7164
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59406-7320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-799-6786
-----------------------------------------------------
Fax | 406-206-0769
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 9TH AVE S UNIT 7164
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59406-7320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-799-6786
-----------------------------------------------------
Fax | 406-206-0769
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRANDON HAWK
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 406-799-6786
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN 11415
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------