Provider Demographics
NPI:1710945829
Name:NEFF, KATHRYN H (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:H
Last Name:NEFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BAKER AVE
Mailing Address - Street 2:GLACIER MEDICAL ASSOCIATES
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2901
Mailing Address - Country:US
Mailing Address - Phone:406-862-2515
Mailing Address - Fax:406-862-4229
Practice Address - Street 1:1111 BAKER AVE
Practice Address - Street 2:GLACIER MEDICAL ASSOCIATES
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2901
Practice Address - Country:US
Practice Address - Phone:406-862-2515
Practice Address - Fax:406-862-4229
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8051207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTCI2709OtherRAILROAD MEDICARE GRP ID#
MT080099316OtherRAILROAD MEDICARE PIN#
MT000008287OtherMEDICARE PART B GRP ID#
MT000097891OtherBLUE CROSS/SHIELD PIN
MT0022646Medicaid
MT1104882232OtherGLACIER MEDICA ASSOC NPI#
MT810350909OtherFEIN
MT8051OtherMONTNA STATE LICENSE
MT27D0411341OtherCLIA ID#--LAB CERT
MT080099316OtherRAILROAD MEDICARE PIN#
MT810350909OtherFEIN
MT0022646Medicaid