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General NPI Number Information
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NPI Number | 1417808965
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Entity Type | Organization
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Legal Business Name | SYLVAN INTEGRATIVE CARE, LLC
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 7 MICROWAVE HILL RD STE C
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City | CLANCY
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State | MT
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Zip | 59634-8001
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Country | US
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Telephone | 406-422-0656
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Fax | 833-471-4087
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Provider Business Mailing Address
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Address Line | 7 MICROWAVE HILL RD STE C
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City | CLANCY
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State | MT
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Zip | 59634-8001
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Country | US
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Telephone | 406-422-0656
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Fax | 833-471-4087
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Authorized Official
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Title or Position | CEO
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Name | DR. MARK DONALD KISHBAUGH
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Credential | DMSC, PA-C
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Telephone | 406-946-2983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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