Provider Demographics
NPI:1487684213
Name:SAME DAY SURGERY CENTER
Entity Type:Organization
Organization Name:SAME DAY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONVERSE
Authorized Official - Suffix:
Authorized Official - Credentials:RN CMSRN
Authorized Official - Phone:406-586-1956
Mailing Address - Street 1:300 NORTH WILLSON
Mailing Address - Street 2:STE 600F
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-586-1956
Mailing Address - Fax:406-587-7656
Practice Address - Street 1:300 NORTH WILLSON
Practice Address - Street 2:STE 600F
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-586-1956
Practice Address - Fax:406-587-7656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9618261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0406861Medicaid
MT000005714Medicare ID - Type Unspecified