Provider Demographics
NPI:1891817011
Name:BOZEMAN FOOT AND ANKLE CLINIC P.C.
Entity Type:Organization
Organization Name:BOZEMAN FOOT AND ANKLE CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NARANJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-587-8478
Mailing Address - Street 1:1050 E MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3823
Mailing Address - Country:US
Mailing Address - Phone:406-587-8478
Mailing Address - Fax:406-582-0730
Practice Address - Street 1:1050 E MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3823
Practice Address - Country:US
Practice Address - Phone:406-587-8478
Practice Address - Fax:406-582-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT129213ES0131X
MT103213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTU24028Medicare UPIN
MTU16493Medicare UPIN
MT0739860001Medicare NSC