1902843816 NPI number — CARDIOLOGY CONSULTANTS OF BOZEMAN PC

Table of content: (NPI 1902843816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902843816 NPI number — CARDIOLOGY CONSULTANTS OF BOZEMAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOLOGY CONSULTANTS OF BOZEMAN PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902843816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5179
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELENA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59604-5179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-443-1556
Provider Business Mailing Address Fax Number:
406-443-4526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 HIGHLAND BLVD
Provider Second Line Business Practice Location Address:
SUITE 4330
Provider Business Practice Location Address City Name:
BOZEMAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59715-6902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-522-3959
Provider Business Practice Location Address Fax Number:
406-586-5941
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ERB
Authorized Official First Name:
BLAIR
Authorized Official Middle Name:
DILLARD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-522-3959

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com