Provider Demographics
NPI:1871685198
Name:BOZEMAN CREEK FAMILY HEALTH, PLLC
Entity Type:Organization
Organization Name:BOZEMAN CREEK FAMILY HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-585-0022
Mailing Address - Street 1:316 E BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4710
Mailing Address - Country:US
Mailing Address - Phone:406-585-0022
Mailing Address - Fax:
Practice Address - Street 1:316 E BABCOCK ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4710
Practice Address - Country:US
Practice Address - Phone:406-585-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000084553Medicare ID - Type UnspecifiedDR. CANNER MEDICARE
MT000084552Medicare ID - Type UnspecifiedDR. CADY MEDICARE NUMBER
MTH56394Medicare UPIN
MT000084554Medicare ID - Type UnspecifiedDR. BRONSKY MEDICARE
MT000084825Medicare ID - Type UnspecifiedDR. PETERSON MEDICARE NUM
MTH87221Medicare UPIN
MTH59198Medicare UPIN
MTG68972Medicare UPIN