Healthcare Provider Details

I. General information

NPI: 1841440765
Provider Name (Legal Business Name): BENJAMIN JOHN MADSEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2008
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 HIGHLAND BLVD STE 1100
BOZEMAN MT
59715-6900
US

IV. Provider business mailing address

915 HIGHLAND BLVD
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-4550
  • Fax: 406-414-4599
Mailing address:
  • Phone: 406-414-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number81116
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMED-PAC-LIC-81116
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: