Basic Information
| Provider Information | |||||||||
| NPI: | 1912137092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | HAVIG | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 HWY 91 SOUTH | ||||||||
| Address2: | |||||||||
| City: | DILLON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597257379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066833000 | ||||||||
| FaxNumber: | 4066831103 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 HWY 91 SOUTH | ||||||||
| Address2: | |||||||||
| City: | DILLON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597257379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066833000 | ||||||||
| FaxNumber: | 4066831103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2009 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25642 | MT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.