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General NPI Number Information
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NPI Number | 1720473788
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Entity Type | Organization
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Legal Business Name | BIG SKY LABS
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 2509 7TH AVE S STE C1
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City | GREAT FALLS
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State | MT
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Zip | 59405-3032
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Country | US
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Telephone | 406-952-0138
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Fax | 406-952-0138
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Provider Business Mailing Address
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Address Line | 2509 7TH AVE S STE C1
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City | GREAT FALLS
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State | MT
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Zip | 59405-3031
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Country | US
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Telephone | 406-952-0138
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Fax | 406-952-0040
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Authorized Official
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Title or Position | CLS TECHNICIAN
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Name | KENNETH HENDRICKS
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Credential |
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Telephone | 406-952-0138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | MT
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