Provider Demographics
NPI:1982736641
Name:KILLPACK, JAMES HEWETT (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HEWETT
Last Name:KILLPACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1 JACKSON CREEK RD PMB 2003
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9714
Mailing Address - Country:US
Mailing Address - Phone:406-459-7681
Mailing Address - Fax:406-494-5869
Practice Address - Street 1:55 BASIN CREEK RD
Practice Address - Street 2:ACADIA MONTANA
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9704
Practice Address - Country:US
Practice Address - Phone:406-459-7681
Practice Address - Fax:406-494-5869
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT95542084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBK8471207OtherDEA
MTB54124Medicare UPIN