Provider Demographics
NPI:1487189874
Name:P.A. KELLY MD PLLC
Entity Type:Organization
Organization Name:P.A. KELLY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRAC
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MADZELONKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:406-541-1400
Mailing Address - Street 1:PO BOX 6011
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-6011
Mailing Address - Country:US
Mailing Address - Phone:406-541-1400
Mailing Address - Fax:406-541-1401
Practice Address - Street 1:2875 TINA AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1581
Practice Address - Country:US
Practice Address - Phone:406-541-1400
Practice Address - Fax:406-541-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11020207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty