=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487684213
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAME DAY SURGERY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 01/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 NORTH WILLSON STE 600F
-----------------------------------------------------
City | BOZEMAN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-586-1956
-----------------------------------------------------
Fax | 406-587-7656
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 NORTH WILLSON STE 600F
-----------------------------------------------------
City | BOZEMAN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-586-1956
-----------------------------------------------------
Fax | 406-587-7656
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | SANDRA L CONVERSE
-----------------------------------------------------
Credential | RN CMSRN
-----------------------------------------------------
Telephone | 406-586-1956
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 9618
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------