Healthcare Provider Details

I. General information

NPI: 1710541131
Provider Name (Legal Business Name): BOZEMAN HEALTH DEACONESS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 HIGHLAND BLVD STE 5410
BOZEMAN MT
59715-6916
US

IV. Provider business mailing address

915 HIGHLAND BLVD STE 2170
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-2400
  • Fax:
Mailing address:
  • Phone: 406-414-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRAD K LUDFORD
Title or Position: CFO
Credential:
Phone: 406-414-1036