Provider Demographics
NPI:1972579431
Name:WHITE, ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BAKER AVE
Mailing Address - Street 2:GLACIER MEDICAL ASSOCIATES
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2901
Mailing Address - Country:US
Mailing Address - Phone:406-862-2515
Mailing Address - Fax:406-862-4229
Practice Address - Street 1:1111 BAKER AVE
Practice Address - Street 2:GLACIER MEDICAL ASSOCIATES
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2901
Practice Address - Country:US
Practice Address - Phone:406-862-2515
Practice Address - Fax:406-862-4229
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10521207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000091456OtherBLUECROSS/SHIELD PIN
MT0355628Medicaid
MTCI2709OtherRAILROAD MEDIARE GRP ID#
MT0150358Medicaid
MT27D0411341OtherCLIA ID#--LAB CERT
MT810350909OtherFEIN
MTP00249493OtherRAILROAD MEDICARE PIN#
MT0000095270OtherBCBS
MT1104882232OtherGLACIER MEDICAL ASSOC NPI
MT000008287OtherMEDICARE PART B GRP ID#
MT0147271Medicaid
MT10521OtherMONTANA STATE LICENSE
MT000008287OtherMEDICARE PART B GRP ID#
MTCI2709OtherRAILROAD MEDIARE GRP ID#
MT27D0411341OtherCLIA ID#--LAB CERT
MT000009945Medicare ID - Type UnspecifiedNVH - ER GRP
MT000084946Medicare PIN