Provider Demographics
NPI:1417257908
Name:MENCEL, MARK R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:R
Last Name:MENCEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:220 SOUTH 16TH AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-381-3308
Mailing Address - Fax:
Practice Address - Street 1:1101 26TH STREET SOUTH
Practice Address - Street 2:BENEFIS HEALTH SYSTEM
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5104
Practice Address - Country:US
Practice Address - Phone:406-455-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-27456363A00000X
NMPA2012-0061363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical