Healthcare Provider Details

I. General information

NPI: 1659855443
Provider Name (Legal Business Name): BOZEMAN DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 BOARDWALK AVE STE 102
BOZEMAN MT
59718-4179
US

IV. Provider business mailing address

610 BOARDWALK AVE STE 102
BOZEMAN MT
59718-4179
US

V. Phone/Fax

Practice location:
  • Phone: 406-624-6727
  • Fax: 833-975-0885
Mailing address:
  • Phone: 406-624-6727
  • Fax: 833-975-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHALAH MCPHERSON
Title or Position: OWNER
Credential:
Phone: 541-868-6051