Provider Demographics
NPI:1356612519
Name:BOZEMAN RHEUMATOLOGY, P.C.
Entity type:Organization
Organization Name:BOZEMAN RHEUMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ECKLUND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-577-2801
Mailing Address - Street 1:1925 N 22ND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7020
Mailing Address - Country:US
Mailing Address - Phone:406-577-2801
Mailing Address - Fax:406-577-2803
Practice Address - Street 1:1925 N 22ND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7020
Practice Address - Country:US
Practice Address - Phone:406-577-2801
Practice Address - Fax:406-577-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8582261QM2500X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty