Provider Demographics
NPI:1346771383
Name:ORTHOPEDIC SURGICAL CENTER OF MONTANA, LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGICAL CENTER OF MONTANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-581-9765
Mailing Address - Street 1:536 S COTTONWOOD RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-9515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:536 S COTTONWOOD RD
Practice Address - Street 2:STE. 100
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-9515
Practice Address - Country:US
Practice Address - Phone:406-586-8029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical