Individual
RANDALL MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10 KRUGER ROAD, PLAINS, MT 59859
(406) 826-4800
Mailing address
10 KRUGER ROAD, PLAINS, MT 59859
(406) 826-4800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MED-PAC-LIC-190
MT
363A00000X
Physician Assistant
PA60595202
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346356359
—
WA
01
—
P01684706
RR MEDICARE WVH
WA
Enumeration date
08/22/2006
Last updated
04/29/2020
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