MEDICARE: KISMET BIG, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist
4	314000000X	Skilled Nursing Facility	9829	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033119722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KISMET BIG, LLC

Provider Business Mailing Address
First Line	:	1050 GRAND DR
Second Line	:
City	:	BIGFORK
State	:	MT
Zip	:	59911-3563
Country	:	US
Telephone Number	:	406-837-5041
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 GRAND DR
Second Line	:
City	:	BIGFORK
State	:	MT
Zip	:	59911
Country	:	US
Telephone Number	:	406-837-5041
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MICHAEL MOORE
Credential	:
Telephone Number	:	605-642-7736

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	03/18/2019

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Directions to “KISMET BIG, LLC ” Practice Location

Language	Start Address	Practice Location

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