Provider Demographics
NPI:1336238518
Name:CHELMO, JEFFERY T (PA)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:T
Last Name:CHELMO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 705
Mailing Address - Street 2:418 W. MONROE
Mailing Address - City:CHESTER
Mailing Address - State:MT
Mailing Address - Zip Code:59522
Mailing Address - Country:US
Mailing Address - Phone:406-759-5194
Mailing Address - Fax:406-759-5105
Practice Address - Street 1:418 WEST MONROE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MT
Practice Address - Zip Code:59522
Practice Address - Country:US
Practice Address - Phone:406-759-5194
Practice Address - Fax:406-759-5105
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT219363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0434350Medicaid
MT0720273Medicaid
MT273994Medicare ID - Type UnspecifiedALL PROVIDER NUMBER
MT970017444Medicare ID - Type UnspecifiedMEDICARE RAILRAOD
MTF90343Medicare UPIN
MTCH5893Medicare ID - Type UnspecifiedGROUP MEDICARE RAILROAD
MT0434350Medicaid
MT0720273Medicaid