Chronic Disease Management, LLC
Organization Active NPI Physician Assistant · Clancy, MT
NPI 1154032472 · NPPES record last updated Jul 27, 2023
Key facts
- NPI
- 1154032472
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physician Assistant 363A00000X
- Legal business name
- CHRONIC DISEASE MANAGEMENT, LLC
- Practice address
- 7 Microwave Hill Rd Ste C
Clancy, MT 59634-8001 - Phone
- (406) 946-2983
- NPI assigned
- Dec 7, 2022
- Organization subpart
- No
Authorized official
- Name
- Dr. Mark Donald Kishbaugh, PA-C
- Title
- Manager
- Phone
- (406) 224-2244
Practitioners 1
-
Mark Donald Kishbaugh, DMSC, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230519000391 | MT | Part B Supplier - Clinic/Group Practice | 1153787064 |
Receives reassigned benefits from 1 practitioner Practice locations: Clancy, MT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Clinic/Center | 261QH0100X | |||
| Physician Assistant |
363A00000X | Yes |
Addresses
Primary practice location
7 Microwave Hill Rd Ste C
Clancy, MT 59634-8001
Mailing address
PO Box 44
Boulder, MT 59632-0044
Phone (406) 224-2244
Other providers in Clancy, MT
- Roger Bisson
- Susan Blum
- Theresa Ann Boomer
- BSCH Clancy LLC
- Emily Ann Burton
- Clancy Nursing and Rehab Center LLC
- Joseph Elliott Cole
- County of Jefferson School District #1
- Angela Cristin Dailey
- Amelia David
All providers in Clancy, MT · Physician Assistant in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.