Jack W. Haas, PA-C
Individual provider Active NPI Physician Assistant · Glendive, MT
NPI 1790701498 · NPPES record last updated Jan 30, 2014
Key facts
- NPI
- 1790701498
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 394 (MT)
- Practice address
- 202 Prospect Dr
Glendive, MT 59330-1943 - Phone
- (406) 345-3306
- Fax
- (406) 345-3358
- NPI assigned
- Jul 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 394 | MT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frances Mahon Deaconess Hospital | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 394 | MT | Yes |
Addresses
Primary practice location
202 Prospect Dr
Glendive, MT 59330-1943
Mailing address
202 Prospect Dr
Glendive, MT 59330-1943
Phone (406) 345-3306
Other providers in Glendive, MT
- Glendive Nursing and Rehab Center, LLC
- Glendive Public Schools
- Tracey Ann Goerndt
- Ashley Grammens
- Dallin Greene
- Albinus Edward Heidt
- Cynthia Kay Heidt
- Daniel Henderson
- Linda Lee Henjum
- Rodney Hickman
All providers in Glendive, 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 Jan 30, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.