Bruce Devin Mikesell, M.D.
Individual provider Active NPI Emergency Medicine Physician · Ronan, MT
NPI 1528099074 · NPPES record last updated Dec 18, 2014
Key facts
- NPI
- 1528099074
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 7984 (MT)
- Practice address
- 107 6TH Ave SW
Ronan, MT 59864-2634 - Phone
- (406) 676-4441
- Fax
- (406) 676-0835
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MT, NE
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040712000424 | MT | Practitioner - Family Practice | 8628055050 | Reassigns benefits to 2 organizations |
| I20240725000808 | NE | Practitioner - Emergency Medicine | 8628055050 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7984 | MT | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Lukes Community Hospital | Current |
Accepting new patients | |
| St Lukes Community Hospital | Current |
Accepting new patients | |
| Community Hospital Association | Current |
Accepting new patients | |
| St. Lukes Community Hospital | Family Medicine | Current | Accepting new patients |
| Community Hospital Association | Current | Accepting new patients | |
| Community Hospital Association | Emergency Medicine | Current |
Accepting new patients |
| Missoula Community Health Services, Inc. | Current | Accepting new patients |
Locations
126 6th Ave SW
Ronan, MT 59864
Phone (406) 676-3600
107 6th Ave SW
Ronan, MT 59864
Phone (406) 676-3600
1208 6th Ave
Superior, MT 59872
Phone (406) 683-3401
1301 E H St
McCook, NE 69001
Phone (308) 344-2650
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 7984 | MT | |
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 7984 | MT | |
| Emergency Medicine Physician | 207P00000X | 7984 | MT | Yes |
Addresses
Primary practice location
107 6TH Ave SW
Ronan, MT 59864-2634
Mailing address
20700 Edith Peak Rd
Huson, MT 59846-9603
Phone (406) 626-5676
Other providers in Ronan, MT
- Marie May
- Jenaia Mae McGreevey
- Bruce M McMillan
- Sarah A.S. Meeks
- Toni Michel
- Mission Mobile Physical Therapy LLC
- Mission Mountain Enterprises, Inc.
- Mission Mountain Home Care LLC
- Mission Valley Eye Center, Inc.
- Mission Valley Wellness, PLLC
All providers in Ronan, MT · Emergency Medicine Physician in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2014. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.