Provider Demographics
NPI:1629064266
Name:SACRY, STEVEN FOREST (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:FOREST
Last Name:SACRY
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:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MT
Mailing Address - Zip Code:59759-0339
Mailing Address - Country:US
Mailing Address - Phone:406-287-3003
Mailing Address - Fax:406-287-3014
Practice Address - Street 1:108 FIRST ST W
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MT
Practice Address - Zip Code:59759-0339
Practice Address - Country:US
Practice Address - Phone:406-287-3003
Practice Address - Fax:406-287-3014
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT360363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT95473OtherBCBS MT PROV ID
MT4302220Medicaid
Q02866OtherUPIN
MT4302207Medicaid
184739200OtherFED WORK COMP GROUP ID
MS1053379OtherDEA
MS1053379OtherDEA
0220790001Medicare NSC
P00099192Medicare PIN
184739200OtherFED WORK COMP GROUP ID