MEDICARE: MEGAN HATTIE PUGH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MED-PAC-LIC-102686	MT

General Provider Information

NPI Number	:	1073266805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN HATTIE PUGH PA-C

Provider Business Mailing Address
First Line	:	375 COMFORT LN
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-9139
Country	:	US
Telephone Number	:	406-599-8915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 6TH AVE
Second Line	:
City	:	SUPERIOR
State	:	MT
Zip	:	59872-9667
Country	:	US
Telephone Number	:	406-822-4841
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	02/01/2022

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