Healthcare Provider Details

I. General information

NPI: 1790766202
Provider Name (Legal Business Name): ADAM W SMITH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 26TH ST S
GREAT FALLS MT
59405-5161
US

IV. Provider business mailing address

1101 26TH ST S
GREAT FALLS MT
59405-5161
US

V. Phone/Fax

Practice location:
  • Phone: 406-455-5000
  • Fax: 406-731-8318
Mailing address:
  • Phone: 406-455-5000
  • Fax: 406-731-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number26376
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: