Provider Demographics
NPI:1235287251
Name:MEDHUS, LOWELL WILLIAM (FNP,PA-C)
Entity Type:Individual
Prefix:
First Name:LOWELL
Middle Name:WILLIAM
Last Name:MEDHUS
Suffix:
Gender:M
Credentials:FNP,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:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-0067
Mailing Address - Country:US
Mailing Address - Phone:406-768-3491
Mailing Address - Fax:406-768-3603
Practice Address - Street 1:550 6TH AVE N
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-0729
Practice Address - Country:US
Practice Address - Phone:406-653-1641
Practice Address - Fax:406-653-3728
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MTRN19426363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT9990118Medicaid
MT8HP473Medicare PIN
MT8HP472Medicare PIN
MT8HZ703Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.
MT8HZ723Medicare PIN
MT9990118Medicaid
MT8HZ713Medicare PIN