Carlye Bolstad, PA-C
Individual provider Active NPI Medical Physician Assistant · Butte, MT
NPI 1528362159 · NPPES record last updated Aug 29, 2019
Key facts
- NPI
- 1528362159
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- MED-PAC-LIC-68538 (MT)
- Practice address
- 3703 Harrison Ave Ste B
Butte, MT 59701-6897 - Phone
- (406) 565-5730
- Fax
- (405) 565-5734
- NPI assigned
- Dec 21, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MED-PAC-LIC-68538 | MT | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premise Health of Montana Medical PC | Current |
Accepting new patients | |
| Premise Health of Montana Medical PC | Past |
Accepting new patients |
Locations
3703 Harrison Ave
Ste B
Butte, MT 59701
Phone (406) 565-5730
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA159424 | OR | |
| Medical Physician Assistant | 363AM0700X | MED-PAC-LIC-68538 | MT | Yes |
Addresses
Primary practice location
3703 Harrison Ave Ste B
Butte, MT 59701-6897
Mailing address
3703 Harrison Ave Ste B
Butte, MT 59701-6897
Phone (406) 565-5730
Other practice location 1
405 Saddle Dr
Helena, MT 59601-5632
Phone (406) 502-1355
Other providers in Butte, MT
- Blue Mountain Counseling
- Bodine Medical LLC
- Jonathan A Bodine
- Kerry Bohlken
- Timothy Bolewicz
- Alyssa Bolton
- Loretta Lynn Bolyard
- Kirstin Ranae Borge
- Jennifer Bosley
- Shelby Box
All providers in Butte, MT · Medical 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 Aug 29, 2019. 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.