Healthcare Provider Details

I. General information

NPI: 1134145139
Provider Name (Legal Business Name): TREASURE STATE ORTHOTIC &PROSTHETIC CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 ELLIS ST SUITE 102
BOZEMAN MT
59715-8810
US

IV. Provider business mailing address

1648 ELLIS ST SUITE 102
BOZEMAN MT
59715-8810
US

V. Phone/Fax

Practice location:
  • Phone: 406-585-1440
  • Fax: 406-585-1438
Mailing address:
  • Phone: 406-585-1440
  • Fax: 406-585-1438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARGARET MURFITT
Title or Position: HR/AP DIRECTOR
Credential:
Phone: 406-585-1440