MEDICARE: BIGFORK FAMILY PRACTICE 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1568765428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIGFORK FAMILY PRACTICE LLC

Provider Business Mailing Address
First Line	:	PO BOX 2944
Second Line	:
City	:	BIGFORK
State	:	MT
Zip	:	59911-2803
Country	:	US
Telephone Number	:	406-837-4357
Fax Number	:	406-837-3957

Provider Business Practice Location Address
First Line	:	7935 MT HWY
Second Line	:	SUITE 201
City	:	BIGFORK
State	:	MT
Zip	:	59911-6294
Country	:	US
Telephone Number	:	406-837-4357
Fax Number	:	406-837-3957

Authorized Official
Title or Position	:	NURSE PRACTITIONER/OWNER
Name	:	MICHELLE HELLWIG
Credential	:	ARNP
Telephone Number	:	406-837-4357

Provider Enumeration Date	:	12/15/2010
Last Update Date	:	02/21/2014

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