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General NPI Number Information
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NPI Number | 1346360203
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Entity Type | Organization
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Legal Business Name | BODINE MEDICAL LLC
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Dates
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Enumeration Date | 04/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 401 S ALABAMA ST SUITE 3B
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City | BUTTE
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State | MT
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Zip | 59701-2315
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Country | US
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Telephone | 406-723-4312
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Fax | 406-723-4316
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Provider Business Mailing Address
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Address Line | 401 S ALABAMA ST SUITE 3B
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City | BUTTE
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State | MT
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Zip | 59701-2315
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Country | US
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Telephone | 406-723-4312
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Fax | 406-723-4316
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. JONATHAN A BODINE
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Credential | DO
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Telephone | 406-723-4312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 10364
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License Number State | MT
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