MEDICARE: MICHAEL J. ROSSI 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	363AS0400X	Surgical Physician Assistant	398	MT
2	363A00000X	Physician Assistant	57092	CA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588664791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J. ROSSI PA-C

Provider Business Mailing Address
First Line	:	2831 FORT MISSOULA RD
Second Line	:	SUITE 232
City	:	MISSOULA
State	:	MT
Zip	:	59804-7419
Country	:	US
Telephone Number	:	406-728-6101
Fax Number	:	406-721-3278

Provider Business Practice Location Address
First Line	:	2831 FORT MISSOULA RD
Second Line	:	SUITE 232
City	:	MISSOULA
State	:	MT
Zip	:	59804-7419
Country	:	US
Telephone Number	:	406-728-6101
Fax Number	:	406-721-3278

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	10/13/2020

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Directions to “ MICHAEL J. ROSSI PA-C” Practice Location

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