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General NPI Number Information
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NPI Number | 1750036174
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Entity Type | Organization
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Legal Business Name | GLACIER SURGICAL INC.
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Dates
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Enumeration Date | 02/14/2022
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 155 TIMBERWOLF PKWY
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City | KALISPELL
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State | MT
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Zip | 59901-1218
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Country | US
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Telephone | 417-889-2040
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Fax |
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Provider Business Mailing Address
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Address Line | 155 TIMBERWOLF PKWY
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City | KALISPELL
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State | MT
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Zip | 59901-1218
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Country | US
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Telephone | 406-257-2020
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MICHELLE GOODMAN
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Credential |
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Telephone | 406-253-3886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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