Healthcare Provider Details

I. General information

NPI: 1285251132
Provider Name (Legal Business Name): WEST BOZEMAN SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 S COTTONWOOD RD SUITE 100
BOZEMAN MT
59718
US

IV. Provider business mailing address

875 S COTTONWOOD RD STE 100
BOZEMAN MT
59718-4208
US

V. Phone/Fax

Practice location:
  • Phone: 972-763-3859
  • Fax:
Mailing address:
  • Phone: 406-219-2800
  • Fax: 406-219-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC BOON
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 480-567-0269