Provider Demographics
NPI:1346360203
Name:BODINE MEDICAL LLC
Entity Type:Organization
Organization Name:BODINE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BODINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:406-723-4312
Mailing Address - Street 1:401 S ALABAMA ST
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2315
Mailing Address - Country:US
Mailing Address - Phone:406-723-4312
Mailing Address - Fax:406-723-4316
Practice Address - Street 1:401 S ALABAMA ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2315
Practice Address - Country:US
Practice Address - Phone:406-723-4312
Practice Address - Fax:406-723-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty