Provider Demographics
NPI:1700662699
Name:BIG SKY MEDICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:BIG SKY MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-551-2180
Mailing Address - Street 1:40 SPANISH PEAK DR UNIT 101-182
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6940
Mailing Address - Country:US
Mailing Address - Phone:702-757-5167
Mailing Address - Fax:
Practice Address - Street 1:155 MILL TOWN LOOP STE A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5146
Practice Address - Country:US
Practice Address - Phone:406-551-2180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty