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General NPI Number Information
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NPI Number | 1932425329
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Entity Type | Individual
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Provider Name | SHAWN C. KELLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 1300 28TH ST S FL 2
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City | GREAT FALLS
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State | MT
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Zip | 59405-5296
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Country | US
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Telephone | 406-455-4320
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Fax | 406-455-4977
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Provider Business Mailing Address
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Address Line | PO BOX 6010
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City | GREAT FALLS
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State | MT
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Zip | 59406-6010
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Country | US
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Telephone | 406-731-8888
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Fax | 406-731-8876
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 67556
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License Number State | MT
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