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NPI Code Detail

MEDICARE: SUSAN E IVANKOVICH PA-C

MEDICARE: SUSAN E IVANKOVICH 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
1363AM0700XMedical Physician Assistant35802MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
124323OTHERNDBCBS
254A23AHOTHERMNBCBS

General Provider Information

NPI Number : 1396799524
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN E IVANKOVICH PA-C
Provider Business Mailing Address
First Line : PO BOX 959
Second Line :
City : COLUMBUS
State : MT
Zip : 59019-0959
Country : US
Telephone Number : 406-322-1000
Fax Number : 406-322-5207
Provider Business Practice Location Address
First Line : 710 11TH ST N
Second Line :
City : COLUMBUS
State : MT
Zip : 59019-7215
Country : US
Telephone Number : 406-322-1000
Fax Number : 406-322-5207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 12/03/2015

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Directions to “ SUSAN E IVANKOVICH PA-C” Practice Location

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