MEDICARE: DR. CHRISS A MACK MD

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	207T00000X	Neurological Surgery Physician	7529	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

General Provider Information

NPI Number	:	1578557377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISS A MACK MD

Provider Business Mailing Address
First Line	:	500 W BROADWAY ST
Second Line	:	SUITE 310
City	:	MISSOULA
State	:	MT
Zip	:	59802-4003
Country	:	US
Telephone Number	:	406-728-6520
Fax Number	:	406-329-2936

Provider Business Practice Location Address
First Line	:	500 W BROADWAY ST
Second Line	:	SUITE 310
City	:	MISSOULA
State	:	MT
Zip	:	59802-4003
Country	:	US
Telephone Number	:	406-728-6520
Fax Number	:	406-329-2936

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	02/08/2008

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