Provider Demographics
NPI:1245250703
Name:LUCE, MELINDA K (PAC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:K
Last Name:LUCE
Suffix:
Gender:F
Credentials:PAC
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 35100
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-5100
Mailing Address - Country:US
Mailing Address - Phone:406-238-2500
Mailing Address - Fax:
Practice Address - Street 1:500 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4008
Practice Address - Country:US
Practice Address - Phone:406-329-7598
Practice Address - Fax:406-721-3907
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT198363A00000X
MTMED-PAC-LIC-198363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000096353OtherBCBS PIN
WY121217600OtherMDCD PIN
MT4305678OtherMDCD PIN
MT000084701Medicare PIN
WYP00233550Medicare PIN
WY121217600OtherMDCD PIN
MTQ44072Medicare UPIN
MT1153260006Medicare PIN