Healthcare Provider Details

I. General information

NPI: 1336238518
Provider Name (Legal Business Name): JEFFERY T. CHELMO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 WEST MONROE
CHESTER MT
59522
US

IV. Provider business mailing address

P.O. BOX 705 418 W. MONROE
CHESTER MT
59522
US

V. Phone/Fax

Practice location:
  • Phone: 406-759-5194
  • Fax: 406-759-5105
Mailing address:
  • Phone: 406-759-5194
  • Fax: 406-759-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number219
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: