Healthcare Provider Details

I. General information

NPI: 1598836850
Provider Name (Legal Business Name): SHANE ALAN HILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 6TH AVE SW
RONAN MT
59864-2634
US

IV. Provider business mailing address

PO BOX 1629
WHITEFISH MT
59937-1629
US

V. Phone/Fax

Practice location:
  • Phone: 406-676-4441
  • Fax:
Mailing address:
  • Phone: 406-314-4683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number11103
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: