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NPI Code Detail

MEDICARE: DR. JACE A BIRD DO

MEDICARE: DR. JACE A BIRD DO
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
1207Q00000XFamily Medicine Physician12468MT
2207Q00000XFamily Medicine Physician45865WI

General Provider Information

NPI Number : 1477627982
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACE A BIRD DO
Provider Business Mailing Address
First Line : 1203 15TH ST
Second Line :
City : FORT BENTON
State : MT
Zip : 59442-7751
Country : US
Telephone Number : 406-622-5485
Fax Number : 406-622-5670
Provider Business Practice Location Address
First Line : 1203 15TH ST
Second Line :
City : FORT BENTON
State : MT
Zip : 59442-7751
Country : US
Telephone Number : 406-622-5485
Fax Number : 406-622-5670
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2006
Last Update Date : 01/28/2022

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