Healthcare Provider Details

I. General information

NPI: 1912137092
Provider Name (Legal Business Name): KELLY HAVIG SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MT HIGHWAY 91 S
DILLON MT
59725-3535
US

IV. Provider business mailing address

600 HWY 91 SOUTH
DILLON MT
59725-7379
US

V. Phone/Fax

Practice location:
  • Phone: 406-683-1188
  • Fax:
Mailing address:
  • Phone: 406-683-3000
  • Fax: 406-683-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25642
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: