Provider Demographics
NPI:1013936244
Name:BOZEMAN CLINIC PLLP
Entity type:Organization
Organization Name:BOZEMAN CLINIC PLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:406-587-4242
Mailing Address - Street 1:931 HIGHLAND BLVD
Mailing Address - Street 2:SUITE 3360
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-587-4242
Mailing Address - Fax:406-587-3507
Practice Address - Street 1:931 HIGHLAND BLVD
Practice Address - Street 2:SUITE 3360
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-587-4242
Practice Address - Fax:406-587-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT8384Medicare ID - Type Unspecified