Basic Information
| Provider Information | |||||||||
| NPI: | 1033472220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROSS | ||||||||
| FirstName: | ARIEL | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 880 | ||||||||
| Address2: | |||||||||
| City: | ST. IGNATIUS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067453525 | ||||||||
| FaxNumber: | 4067453529 | ||||||||
| Practice Location | |||||||||
| Address1: | 35959 BIG KNIFE LANE | ||||||||
| Address2: | |||||||||
| City: | PABLO | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067528433 | ||||||||
| FaxNumber: | 4067566768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2012 | ||||||||
| LastUpdateDate: | 10/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 32693 | MT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | 156936 | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | MED-PAC-LIC-32693 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.