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NPI Code Detail

MEDICARE: BLAINE G WHITE PA-C

MEDICARE: BLAINE G WHITE 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
1363A00000XPhysician Assistant19305MT

General Provider Information

NPI Number : 1568718179
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAINE G WHITE PA-C
Provider Business Mailing Address
First Line : 621 3RD ST S
Second Line :
City : GLASGOW
State : MT
Zip : 59230-2651
Country : US
Telephone Number : 406-228-3645
Fax Number : 406-228-3533
Provider Business Practice Location Address
First Line : 621 3RD ST S
Second Line :
City : GLASGOW
State : MT
Zip : 59230-2604
Country : US
Telephone Number : 406-228-3645
Fax Number : 406-228-3533
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2012
Last Update Date : 03/04/2026

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Directions to “ BLAINE G WHITE PA-C” Practice Location

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