Provider Demographics
NPI:1124625116
Name:NUTRITION UNDER THE BIG SKY
Entity type:Organization
Organization Name:NUTRITION UNDER THE BIG SKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILIN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LN
Authorized Official - Phone:406-208-7761
Mailing Address - Street 1:PO BOX 6102
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-6102
Mailing Address - Country:US
Mailing Address - Phone:406-208-7761
Mailing Address - Fax:
Practice Address - Street 1:562 ENTERPRISE BLVD APT 49
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5133
Practice Address - Country:US
Practice Address - Phone:406-208-7761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-03
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center