Provider Demographics
NPI:1437529112
Name:BOZEMAN HEALTH DEACONESS HOSPITAL
Entity Type:Organization
Organization Name:BOZEMAN HEALTH DEACONESS HOSPITAL
Other - Org Name:BOZEMAN HEALTH DEACONESS HOSPITAL ER PROVIDERS
Other - Org Type:Other Name
Authorized Official - Title/Position:PFS CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-414-1826
Mailing Address - Street 1:915 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6902
Mailing Address - Country:US
Mailing Address - Phone:406-414-5000
Mailing Address - Fax:404-414-1071
Practice Address - Street 1:915 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6902
Practice Address - Country:US
Practice Address - Phone:406-414-5000
Practice Address - Fax:404-414-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011006959Medicare Oscar/Certification