MEDICARE: MS. LAUREL G. CHAMBERS P.A.-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	363AM0700X	Medical Physician Assistant	249	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	93073	OTHER	MT	BC/BS OF MONTANA

General Provider Information

NPI Number	:	1154334712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREL G. CHAMBERS P.A.-C

Provider Business Mailing Address
First Line	:	1208 6TH AVE
Second Line	:	P.O. BOX 698
City	:	SUPERIOR
State	:	MT
Zip	:	59872-9618
Country	:	US
Telephone Number	:	406-822-4278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 6TH AVE
Second Line	:
City	:	SUPERIOR
State	:	MT
Zip	:	59872-9618
Country	:	US
Telephone Number	:	406-822-4278
Fax Number	:	406-822-4912

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	12/27/2007

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Directions to “ MS. LAUREL G. CHAMBERS P.A.-C” Practice Location

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