Healthcare Provider Details

I. General information

NPI: 1861127730
Provider Name (Legal Business Name): LACEY ELAINE MCGREE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2022
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2442 WINNE AVE
HELENA MT
59601-4921
US

IV. Provider business mailing address

685 LEGEND LOOP APT F103
HELENA MT
59602-8658
US

V. Phone/Fax

Practice location:
  • Phone: 406-457-4100
  • Fax: 406-457-4110
Mailing address:
  • Phone: 406-565-3529
  • Fax: 406-457-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number129305
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: