Provider Demographics
NPI:1750260477
Name:LITTLE SHELL TRIBE OF CHIPPEWA INDIANS OF MONTANA
Entity type:Organization
Organization Name:LITTLE SHELL TRIBE OF CHIPPEWA INDIANS OF MONTANA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:406-315-2400
Mailing Address - Street 1:511 CENTRAL AVE W
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-2848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 SMELTER AVE NE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1927
Practice Address - Country:US
Practice Address - Phone:406-247-7130
Practice Address - Fax:406-315-2401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE SHELL TRIBE OF CHIPPEWA INDIANS OF MONTANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy