Provider Demographics
NPI:1134145139
Name:TREASURE STATE ORTHOTIC &PROSTHETIC CLINIC, INC
Entity type:Organization
Organization Name:TREASURE STATE ORTHOTIC &PROSTHETIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR/AP DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:MURFITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-585-1440
Mailing Address - Street 1:1648 ELLIS ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8810
Mailing Address - Country:US
Mailing Address - Phone:406-585-1440
Mailing Address - Fax:406-585-1438
Practice Address - Street 1:1648 ELLIS ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8810
Practice Address - Country:US
Practice Address - Phone:406-585-1440
Practice Address - Fax:406-585-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5607407Medicaid
MT5592720001Medicare ID - Type Unspecified