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NPI Code Detail

MEDICARE: JILL C POWELL PAC

MEDICARE: JILL C POWELL PAC
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
1363A00000XPhysician Assistant606MT
2363AM0700XMedical Physician AssistantMED-PAC-LIC-606MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1902743OTHERMTBCBS

General Provider Information

NPI Number : 1205168150
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL C POWELL PAC
Provider Business Mailing Address
First Line : PO BOX 35100
Second Line :
City : BILLINGS
State : MT
Zip : 59107-5100
Country : US
Telephone Number : 406-238-2500
Fax Number :
Provider Business Practice Location Address
First Line : 760 WICKS LN
Second Line :
City : BILLINGS
State : MT
Zip : 59105-4427
Country : US
Telephone Number : 406-238-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2010
Last Update Date : 12/14/2021

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