MEDICARE: DR. SUSAN J EFFERTZ MD

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	208M00000X	Hospitalist Physician	4673	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	:	1275534166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN J EFFERTZ MD

Provider Business Mailing Address
First Line	:	6 BEAR PAW PL
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-6438
Country	:	US
Telephone Number	:	406-727-2442
Fax Number	:

Provider Business Practice Location Address
First Line	:	3687 VETERANS DRIVE
Second Line	:	FORT HARRISON
City	:	HELENA
State	:	MT
Zip	:	59636-1500
Country	:	US
Telephone Number	:	877-468-8387
Fax Number	:

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/19/2010

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