MEDICARE: DR. MARK DONALD KISHBAUGH DMSC, 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	43812	MT

General Provider Information

NPI Number	:	1467410803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK DONALD KISHBAUGH DMSC, PA-C

Provider Business Mailing Address
First Line	:	PO BOX 312
Second Line	:
City	:	JEFFERSON CITY
State	:	MT
Zip	:	59638-0312
Country	:	US
Telephone Number	:	406-224-2244
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 MICROWAVE HILL RD STE C
Second Line	:
City	:	CLANCY
State	:	MT
Zip	:	59634-8001
Country	:	US
Telephone Number	:	406-422-0656
Fax Number	:	833-471-4087

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	02/09/2026

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