MEDICARE: MRS. JANE E TAYLOR PAC

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	363AM0700X	Medical Physician Assistant	439	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
2	000096973	OTHER	MT	BC & BS

General Provider Information

NPI Number	:	1558383323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANE E TAYLOR PAC

Provider Business Mailing Address
First Line	:	PO BOX 969
Second Line	:
City	:	THOMPSON FALLS
State	:	MT
Zip	:	59873-0969
Country	:	US
Telephone Number	:	406-827-4307
Fax Number	:	406-827-9514

Provider Business Practice Location Address
First Line	:	907 MAIN ST
Second Line	:
City	:	THOMPSON FALLS
State	:	MT
Zip	:	59873
Country	:	US
Telephone Number	:	406-827-4307
Fax Number	:	406-827-9514

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	05/16/2013

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Directions to “ MRS. JANE E TAYLOR PAC” Practice Location

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