Active NPI
Max Garrison Mitchell, RN
- General Practice Registered Nurse
- Poplar, MT
National Provider Identifier
1861761967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Registered Nurse
- License
- N-38315
- Practice address
- 107 H Street
Poplar, MT 59255-0067 - Phone
- (406) 768-2156
- Fax
- (406) 768-5109
- NPI assigned
- Dec 19, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | N-38315 | ID | Primary |
Addresses
Primary practice location
107 H Street
Poplar, MT 59255-0067
Mailing address
107 H Street
Poplar, MT 59255-0067
Phone (406) 768-2156
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2220068 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N-38315 | ID | MD | General Practice Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324252800000",
"number": "1861761967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 H STREET",
"city": "POPLAR",
"state": "MT",
"postal_code": "592550067",
"telephone_number": "406-768-2156",
"fax_number": "406-768-5109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 H STREET",
"city": "POPLAR",
"state": "MT",
"postal_code": "592550067",
"telephone_number": "406-768-2156",
"fax_number": "406-768-5109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "MAX",
"middle_name": "GARRISON",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-19",
"last_updated": "2011-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "ID",
"license": "N-38315",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2220068",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Poplar, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.