Provider Demographics
NPI:1346402963
Name:MIRNA D BOWDEN MD PC
Entity Type:Organization
Organization Name:MIRNA D BOWDEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-862-6436
Mailing Address - Street 1:2002 HOSPITAL WAY
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937
Mailing Address - Country:US
Mailing Address - Phone:406-862-6436
Mailing Address - Fax:406-862-9978
Practice Address - Street 1:2002 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937
Practice Address - Country:US
Practice Address - Phone:406-862-6436
Practice Address - Fax:406-862-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT10075207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT91065OtherBCBS
MT0151215Medicaid
MTH70796Medicare UPIN
000082795Medicare PIN