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General NPI Number Information
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NPI Number | 1184640104
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Entity Type | Organization
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Legal Business Name | BOHANNON CREEK ENTERPRISES, INC.
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 90 HIGHWAY 91 SOUTH
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City | DILLON
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State | MT
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Zip | 59725-3516
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Country | US
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Telephone | 406-683-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34940
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City | SEATTLE
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State | WA
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Zip | 98124-1940
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Country | US
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Telephone | 503-372-2740
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Fax | 503-372-2754
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Authorized Official
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Title or Position | PRESIDENT
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Name | GORDON H. LUCAS
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Credential | CRNA
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Telephone | 503-372-2740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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