MEDICARE: BRADY SCOTT RUFF P.A. - C

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	363A00000X	Physician Assistant	542	MT

General Provider Information

NPI Number	:	1801046503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADY SCOTT RUFF P.A. - C

Provider Business Mailing Address
First Line	:	383 N 17TH AVE
Second Line	:
City	:	FORSYTH
State	:	MT
Zip	:	59327-0268
Country	:	US
Telephone Number	:	406-346-2161
Fax Number	:

Provider Business Practice Location Address
First Line	:	383 N 17TH AVE
Second Line	:
City	:	FORSYTH
State	:	MT
Zip	:	59327-0268
Country	:	US
Telephone Number	:	406-346-2161
Fax Number	:

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

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	09/30/2008

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