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General NPI Number Information
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NPI Number | 1912212838
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Entity Type | Organization
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Legal Business Name | GLACIER HEALTHCARE, LLC
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 416 W. 15TH STREET BUILDING 400, SUITE B
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City | EDMOND
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State | OK
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Zip | 73013-3688
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Country | US
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Telephone | 405-285-8900
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Fax | 405-285-8921
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Provider Business Mailing Address
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Address Line | 416 W 15TH ST BUILDING 400, SUITE B
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City | EDMOND
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State | OK
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Zip | 73013-3747
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Country | US
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Telephone | 405-285-8900
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Fax | 405-285-8921
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHAD EMERY HUFFMYER
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Credential |
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Telephone | 405-285-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 152W00000X
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Taxonomy Name | Optometrist
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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 | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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