1689890477 NPI number — BOZEMAN SCHOOL DISTRICT #7

Table of content: DR. JESSIE SARA GLASSER MD (NPI 1487744314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689890477 NPI number — BOZEMAN SCHOOL DISTRICT #7

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOZEMAN SCHOOL DISTRICT #7
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:
1689890477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
404 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOZEMAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59715-4579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-522-6042
Provider Business Mailing Address Fax Number:
406-522-6050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOZEMAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59715-4579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-522-6042
Provider Business Practice Location Address Fax Number:
406-522-6050
Provider Enumeration Date:
04/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
DWAYNE
Authorized Official Title or Position:
ASST. SUPERINTENDENT OF BUSINESS
Authorized Official Telephone Number:
406-522-6042

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0164764 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0166166 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".