Healthcare Provider Details

I. General information

NPI: 1750890232
Provider Name (Legal Business Name): BOZEMAN HEALTH CONVENIENCE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 09/02/2025
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 OAK ST STE 3
BOZEMAN MT
59715-8847
US

IV. Provider business mailing address

ATTENTION: COMPLIANCE 915 HIGHLAND BLVD
BOZEMAN MT
59715
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-4890
  • Fax: 406-414-4894
Mailing address:
  • Phone: 406-414-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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