Provider Demographics
NPI:1750890232
Name:BOZEMAN HEALTH CONVENIENCE CARE, LLC
Entity type:Organization
Organization Name:BOZEMAN HEALTH CONVENIENCE CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-414-1036
Mailing Address - Street 1:ATTENTION: COMPLIANCE
Mailing Address - Street 2:915 HIGHLAND BLVD
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-414-5552
Mailing Address - Fax:
Practice Address - Street 1:1805 OAK ST STE 3
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8847
Practice Address - Country:US
Practice Address - Phone:406-414-4890
Practice Address - Fax:406-414-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center