Provider Demographics
NPI:1124010830
Name:ETCHART, JOHN S (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:ETCHART
Suffix:
Gender:M
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 1:2900 12TH AVE N
Mailing Address - Street 2:SUITE 305E.
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7506
Mailing Address - Country:US
Mailing Address - Phone:406-237-5750
Mailing Address - Fax:406-237-5745
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:SUITE 305E.
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-237-5750
Practice Address - Fax:406-237-5745
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT435693Medicaid
MT81499Medicare ID - Type Unspecified
MT435693Medicaid