Healthcare Provider Details

I. General information

NPI: 1699874727
Provider Name (Legal Business Name): BITTERROOT FOOT & ANKLE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N 10TH ST STE B
HAMILTON MT
59840-2318
US

IV. Provider business mailing address

330 N 10TH ST STE B
HAMILTON MT
59840-2318
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-4214
  • Fax: 406-363-4354
Mailing address:
  • Phone: 406-363-4214
  • Fax: 406-363-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number169
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CHAD R. DICKEMORE
Title or Position: OWNER
Credential: DPM
Phone: 406-363-4214