MEDICARE: BIG SKY FAMILY HEALTH CLINIC

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	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1427536242	OTHER	MT	INDIVIDUAL TYPE 1 NPI NUMBER

General Provider Information

NPI Number	:	1831802289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIG SKY FAMILY HEALTH CLINIC

Provider Business Mailing Address
First Line	:	2210 HARRISON AVE
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-6068
Country	:	US
Telephone Number	:	406-792-6239
Fax Number	:	406-299-2448

Provider Business Practice Location Address
First Line	:	2210 HARRISON AVE
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-6068
Country	:	US
Telephone Number	:	406-792-6239
Fax Number	:	406-299-2448

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ANDREA RAPP
Credential	:
Telephone Number	:	406-792-6239

Provider Enumeration Date	:	12/30/2022
Last Update Date	:	12/30/2022

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Directions to “BIG SKY FAMILY HEALTH CLINIC ” Practice Location

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