Provider Demographics
NPI:1447363916
Name:VELK, MARY C (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:VELK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-2600
Mailing Address - Country:US
Mailing Address - Phone:406-676-3600
Mailing Address - Fax:406-676-3738
Practice Address - Street 1:2835 FORT MISSOULA RD STE 202
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7424
Practice Address - Country:US
Practice Address - Phone:406-728-4292
Practice Address - Fax:406-728-5770
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4306066Medicaid
MTQ10667Medicare UPIN
MT000084745Medicare PIN
MT4306066Medicaid
MT000084744Medicare PIN