SHANE ADAM MCCULLOUGH (NPI# 1891190658) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891190658 |
| Entity Type | Individual |
| Full Name | SHANE ADAM MCCULLOUGH |
| Credential | PA-C |
| Practice Address |
2900 12th Ave N Ste 140w Billings MT 59101-7507 |
| Mailing Address |
1572 Henry Dr Laramie WY 82072-2351 |
| Practice Telephone | 4062375050 |
| Practice Fax Number | 4062386599 |
| Mailing Telephone | 4068617624 |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2017-12-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 59046 | MT | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | PT622 | WY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2900 12TH AVE N STE 140W |
| City | BILLINGS |
| State | MT |
| Zip Code | 59101-7507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790782043 | Gwenna Peters | Physical Therapist | 2900 12th Ave N Ste 140w, Billings, MT 59101-7507 | 2005-07-01 |
| 1134727977 | Kathryn Schwartz | Physician Assistant | 2900 12th Ave N Ste 140w, Billings, MT 59101-7507 | 2020-10-14 |
| 1609473412 | Zachary Molyneaux | Physician Assistant | 2900 12th Ave N Ste 140w, Billings, MT 59101-7507 | 2020-10-05 |
| 1508496217 | Kolten Wenckus | Physician Assistant | 2900 12th Ave N Ste 140w, Billings, MT 59101-7507 | 2020-01-22 |
| 1740826668 | Jill Kerns | Nurse Practitioner | 2900 12th Ave N Ste 140w, Billings, MT 59101-7507 | 2019-11-26 |
| 1356985014 | Tyler C Miller | Physician Assistant | 2900 12th Ave N Ste 140w, Billings, MT 59101-7507 | 2019-11-05 |
| 1144880923 | Regan Bold | Physical Therapist | 2900 12th Ave N Ste 140w, Billings, MT 59101-7507 | 2019-06-14 |
| 1487139770 | Nicholas G Smith | Physician Assistant | 2900 12th Ave N Ste 140w, Billings, MT 59101-7507 | 2018-10-02 |
| 1760992929 | Christopher Hines | Physician Assistant | 2900 12th Ave N Ste 140w, Billings, MT 59101-7507 | 2017-10-02 |
| 1649799297 | Libby N Close | Physician Assistant | 2900 12th Ave N Ste 140w, Billings, MT 59101-7507 | 2017-09-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356950927 | Rayola Carol Grant | Student in an Organized Health Care Education/Training Program | Montana State University College of Nursing, Billing Ce, Ap 306 1500 University Drive, Billings, MT 59101 | 2020-07-29 |
| 1225652001 | Johnny L Talawyma Jr. | Peer Specialist | 1230 N. 30th St. Suite 100, Billings, MT 59101 | 2020-06-08 |
| 1306487962 | Jeannine L. Walter | Technician | 26 Peters St, Billings, MT 59101 | 2019-10-04 |
| 1912470089 | Deidre Jenae Johnson | Student in an Organized Health Care Education/Training Program | 1500 University Drive, Rimrock 503, Billings, MT 59101 | 2019-01-10 |
| 1649743964 | Annika Stampfel | Behavior Technician | 780 Broadwater Avenue, Billings, MT 59101 | 2019-01-09 |
| 1215436092 | Yellowstone City-county Health Department | Clinic/Center | 515 N 27th St, Billings, MT 59101 | 2018-02-07 |
| 1902305790 | Yellowstone City-county Health Department | Clinic/Center | 3005 1st Ave S, Billings, MT 59101 | 2018-02-07 |
| 1720587512 | Yellowstone City-county Health Department | Clinic/Center | 120 Jackson Street, Billings, MT 59101 | 2018-02-07 |
| 1508385477 | Jkw & Jira Inc. | Pharmacy | 1245 N 29th St Ste 100, Billings, MT 59101 | 2017-09-12 |
| 1487198610 | Rebecca Webber | Counselor | 251 Rolling Meadow Dr, Billings, MT 59101 | 2016-12-07 |
| Find all providers in zip 59101 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972019925 | Kevin K Davis Jr. | Physician Assistant | 1101 N 27th St Ste F, Billings, MT 59101-0100 | 2017-12-28 |
| 1154770014 | Kristin K. Nelson Baumert | Physician Assistant | 3737 Grand Ave., Suite 6, Billings, MT 59102-6258 | 2016-06-10 |
| 1508232588 | Elliy Phillips | Physician Assistant | 801 N 29th St Fl 4, Billings, MT 59101-0905 | 2015-08-13 |
| 1366843914 | Chad Jason Holgard | Physician Assistant | 445 Constitution Ave, Billings, MT 59105-1515 | 2014-09-12 |
| 1144528258 | Kristine Marie Lippert | Physician Assistant | 1041 N. 29th Street, Billings, MT 59101 | 2011-03-14 |
| 1720383813 | Max D Dangerfield | Physician Assistant | 2525 4th Ave N, Suite 201, Billings, MT 59101-1312 | 2011-01-20 |
| 1902033442 | Amber Dawn Zito | Physician Assistant | 1020 N 27th St Ste 301, Billings, MT 59101-0756 | 2009-06-11 |
| 1194924621 | Matt T Furber | Physician Assistant | 2900 12th Ave N Ste 265w, Billings, MT 59101-7501 | 2007-07-14 |
| 1356566434 | Anne E Burns | Physician Assistant | 3307 Grand Ave Ste 201, Billings, MT 59102-6551 | 2007-04-16 |
| 1487646949 | John L Swanson | Physician Assistant | 2825 8th Ave N, Billings, MT 59101-0909 | 2005-08-19 |
| Find all providers in BILLINGS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.