# GLACIER MEDICAL ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104882232
- **Authorized official:** MS. KELLI D MEUCHEL (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (406) 862-2515

## Contact information

- **Practice address:** 1111 BAKER AVE, WHITEFISH, MT 59937-2901
- **Practice address phone:** (406) 862-2515
- **Practice address fax:** (406) 862-4229
- **Mailing address:** 1111 BAKER AVE, WHITEFISH, MT 59937-2901
- **Mailing address phone:** (406) 862-2515
- **Mailing address fax:** (406) 862-4229

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 04/26/2006
- **Last updated:** 03/25/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0026899 | WASH. DEP LABOR GRP ID\# | WA |
| 01 | — | 1104882232 | GLACIER MEDICAL ASSOC NPI | MT |
| 01 | — | 27D0411341 | CLIA ID\#--LAB CERT | MT |
| 05 | — | 99882551 | — | MT |