Organization
GLACIER PROSTHETIC CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GINA CARPENTER (VICE PRESIDENT)
(406) 755-3344
Entity
Organization
Contact information
Practice address
205 VERMEER DR, SUITE C, PONDERAY, ID 83852-1660
(208) 255-4106
(208) 255-4102
Mailing address
985 N MERIDIAN RD, KALISPELL, MT 59901-3539
(406) 755-3344
(406) 755-2746
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
385
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807555300
—
ID
Enumeration date
03/05/2007
Last updated
11/18/2009
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