Organization
GREAT FALLS CLINIC SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHERYL D CORNWELL (CHIEF FINANCIAL OFFICER)
(406) 216-8057
Entity
Organization
Contact information
Practice address
1509 29TH ST S, GREAT FALLS, MT 59405-5363
(406) 771-3500
(406) 771-3501
Mailing address
1509 29TH ST S, GREAT FALLS, MT 59405-5363
(406) 771-3500
(406) 771-3502
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
9722
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0350829
—
MT
01
—
27C0001016
CMS (FORMERLY HCFA)
—
Enumeration date
08/02/2005
Last updated
07/20/2011
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