Provider Demographics
NPI:1316519630
Name:GREAT BEAR HEALTH
Entity type:Organization
Organization Name:GREAT BEAR HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:H
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:406-471-8139
Mailing Address - Street 1:1077 WHITEFISH STAGE
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2735
Mailing Address - Country:US
Mailing Address - Phone:406-471-8139
Mailing Address - Fax:888-701-8139
Practice Address - Street 1:1077 WHITEFISH STAGE
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2735
Practice Address - Country:US
Practice Address - Phone:406-471-8139
Practice Address - Fax:888-701-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty