Organization
GLACIER MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLI D MEUCHEL (PRACTICE ADMINISTRATOR)
(406) 862-2515
Entity
Organization
Contact information
Practice address
1111 BAKER AVE, WHITEFISH, MT 59937-2901
(406) 862-2515
(406) 862-4229
Mailing address
1111 BAKER AVE, WHITEFISH, MT 59937-2901
(406) 862-2515
(406) 862-4229
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
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
Enumeration date
04/26/2006
Last updated
03/25/2014
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