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General NPI Number Information
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NPI Number | 1780904474
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Entity Type | Organization
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Legal Business Name | GLACIER PROSTHETIC CARE, INC.
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 1110 W PARK PL SUITE 202
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2781
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Country | US
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Telephone | 208-667-3344
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Fax | 208-667-2745
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Provider Business Mailing Address
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Address Line | 985 N MERIDIAN RD
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City | KALISPELL
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State | MT
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Zip | 59901-3539
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Country | US
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Telephone | 406-755-3344
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Fax | 406-755-2746
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | GINA CARPENTER
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Credential |
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Telephone | 406-755-3344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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