MEDICARE: MR. JIM M MCLEAN PT,CSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	568	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61825	OTHER	MT	BCBS
2	MSF0952741	OTHER	MT	MT STATE FUND WORK COMP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144201922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JIM M MCLEAN PT,CSCS

Provider Business Mailing Address
First Line	:	PO BOX 767
Second Line	:
City	:	FRENCHTOWN
State	:	MT
Zip	:	59834-0767
Country	:	US
Telephone Number	:	406-626-0026
Fax Number	:

Provider Business Practice Location Address
First Line	:	16600 BECKWITH ROAD
Second Line	:
City	:	FRENCHTOWN
State	:	MT
Zip	:	59834
Country	:	US
Telephone Number	:	406-262-0026
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/08/2007

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