MEDICARE: LOWELL WILLIAM MEDHUS FNP,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
2	363LF0000X	Family Nurse Practitioner	RN19426	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

General Provider Information

NPI Number	:	1235287251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOWELL WILLIAM MEDHUS FNP,PA-C

Provider Business Mailing Address
First Line	:	PO BOX 67
Second Line	:
City	:	POPLAR
State	:	MT
Zip	:	59255-0067
Country	:	US
Telephone Number	:	406-768-3491
Fax Number	:	406-768-3603

Provider Business Practice Location Address
First Line	:	550 6TH AVE N
Second Line	:
City	:	WOLF POINT
State	:	MT
Zip	:	59201-0729
Country	:	US
Telephone Number	:	406-653-1641
Fax Number	:	406-653-3728

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	01/17/2013

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