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General NPI Number Information
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NPI Number | 1649970526
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Entity Type | Organization
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Legal Business Name | LITTLE SHELL TRIBE OF CHIPPEWA INDIANS OF MONTANA
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 425 SMELTER AVE NE
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City | GREAT FALLS
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State | MT
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Zip | 59404-1927
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Country | US
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Telephone | 406-247-7130
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Fax |
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Provider Business Mailing Address
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Address Line | 511 CENTRAL AVE W
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City | GREAT FALLS
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State | MT
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Zip | 59404-2848
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Country | US
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Telephone | 406-315-2400
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Fax | 406-315-2401
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Authorized Official
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Title or Position | CHAIRMAN
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Name | GERALD GRAY JR.
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Credential |
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Telephone | 406-315-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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