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General NPI Number Information
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NPI Number | 1326552944
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Entity Type | Organization
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Legal Business Name | GREAT WESTERN MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 11/17/2017
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 118 PAUL BUNYAN DR S
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City | BEMIDJI
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State | MN
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Zip | 56601-3236
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Country | US
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Telephone | 218-770-9881
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Fax |
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Provider Business Mailing Address
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Address Line | 118 PAUL BUNYAN DR S
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City | BEMIDJI
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State | MN
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Zip | 56601-3236
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN ADAM HAMILTON
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Credential | MD
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Telephone | 218-770-9881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 53573
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License Number State | MN
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