Provider Demographics
NPI:1639288764
Name:HURSH, TERY ALLEN (PA-C)
Entity type:Individual
Prefix:
First Name:TERY
Middle Name:ALLEN
Last Name:HURSH
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 1:120 S. ATLANTIC
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725
Mailing Address - Country:US
Mailing Address - Phone:406-683-4400
Mailing Address - Fax:406-683-4408
Practice Address - Street 1:120 S. ATLANTIC
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725
Practice Address - Country:US
Practice Address - Phone:406-683-4400
Practice Address - Fax:406-683-4408
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT465363A00000X
MTPA465363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant