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NPI Code Detail

MEDICARE: TIMOTHY J DEVRIES PAC

MEDICARE: TIMOTHY J DEVRIES 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
1363AS0400XSurgical Physician Assistant622MT
2363AS0400XSurgical Physician Assistant211MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487644597
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY J DEVRIES PAC
Provider Business Mailing Address
First Line : 111 SUNNYVIEW LN
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3164
Country : US
Telephone Number : 406-752-7900
Fax Number : 406-257-0253
Provider Business Practice Location Address
First Line : 111 SUNNYVIEW LN
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3164
Country : US
Telephone Number : 406-752-7900
Fax Number : 406-257-0253
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2005
Last Update Date : 11/27/2023

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