Provider Demographics
NPI:1023100732
Name:BIG SKY INTERNAL MEDICINE
Entity type:Organization
Organization Name:BIG SKY INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRENSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-535-1490
Mailing Address - Street 1:310 WENDELL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2267
Mailing Address - Country:US
Mailing Address - Phone:406-535-1490
Mailing Address - Fax:406-535-1491
Practice Address - Street 1:310 WENDELL AVE STE 101
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2267
Practice Address - Country:US
Practice Address - Phone:406-535-1490
Practice Address - Fax:406-535-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000008992Medicare ID - Type Unspecified