Provider Demographics
NPI:1649362682
Name:BITTERROOT VALLEY ORTHOPAEDIC & FRACTURE CLINIC
Entity type:Organization
Organization Name:BITTERROOT VALLEY ORTHOPAEDIC & FRACTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUDD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-375-4791
Mailing Address - Street 1:1200 WESTWOOD DR
Mailing Address - Street 2:STE H
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2345
Mailing Address - Country:US
Mailing Address - Phone:406-375-4791
Mailing Address - Fax:406-375-4794
Practice Address - Street 1:1200 WESTWOOD DR
Practice Address - Street 2:STE H
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2345
Practice Address - Country:US
Practice Address - Phone:406-375-4791
Practice Address - Fax:406-375-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9981207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTF80688Medicare UPIN