Provider Demographics
NPI:1659855443
Name:BOZEMAN DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:BOZEMAN DIAGNOSTICS LLC
Other - Org Name:SOUND DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHALAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-868-6051
Mailing Address - Street 1:610 BOARDWALK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4179
Mailing Address - Country:US
Mailing Address - Phone:406-624-6727
Mailing Address - Fax:833-975-0885
Practice Address - Street 1:610 BOARDWALK AVE STE 102
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4179
Practice Address - Country:US
Practice Address - Phone:406-624-6727
Practice Address - Fax:833-975-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology