MEDICARE: STEVEN FOREST SACRY 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	363A00000X	Physician Assistant	360	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95473	OTHER	MT	BCBS MT PROV ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	Q02866	OTHER		UPIN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	184739200	OTHER		FED WORK COMP GROUP ID

General Provider Information

NPI Number	:	1629064266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN FOREST SACRY PA-C

Provider Business Mailing Address
First Line	:	PO BOX 339
Second Line	:
City	:	WHITEHALL
State	:	MT
Zip	:	59759-0339
Country	:	US
Telephone Number	:	406-287-3003
Fax Number	:	406-287-3014

Provider Business Practice Location Address
First Line	:	108 FIRST ST W
Second Line	:
City	:	WHITEHALL
State	:	MT
Zip	:	59759-0339
Country	:	US
Telephone Number	:	406-287-3003
Fax Number	:	406-287-3014

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	03/07/2023

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Directions to “ STEVEN FOREST SACRY PA-C” Practice Location

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