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NPI Code Detail

MEDICARE: LISA RENE ROSS M.D.

MEDICARE: LISA RENE ROSS M.D.
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
1207V00000XObstetrics & Gynecology Physician34661IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1122154000OTHERWYMDCD PIN
2000092716OTHERMTBCBS PIN
30150917OTHERMTMDCD PIN
410978OTHERMTSTATE LICENSE

General Provider Information

NPI Number : 1831181924
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA RENE ROSS M.D.
Provider Business Mailing Address
First Line : 216 14TH AVE SW
Second Line :
City : SIDNEY
State : MT
Zip : 59270-3519
Country : US
Telephone Number : 406-488-2577
Fax Number : 406-488-2580
Provider Business Practice Location Address
First Line : 214 14TH AVE SW
Second Line :
City : SIDNEY
State : MT
Zip : 59270-3521
Country : US
Telephone Number : 406-488-2100
Fax Number : 406-488-2125
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 11/12/2020

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