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General NPI Number Information
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NPI Number | 1841320629
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF BOZEMAN, PC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 925 HIGHLAND BOULEVARD SUITE 1200
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City | BOZEMAN
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State | MT
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Zip | 59715-6900
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Country | US
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Telephone | 406-587-0704
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Fax | 406-587-1147
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Provider Business Mailing Address
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Address Line | 925 HIGHLAND BOULEVARD SUITE 1200
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City | BOZEMAN
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State | MT
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Zip | 59715-6900
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Country | US
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Telephone | 406-587-0704
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Fax | 406-587-1147
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | KELLY L BANKS
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Credential | M.D.
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Telephone | 406-587-0704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 15264
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4000
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 6438
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License Number State | MT
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 9898
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License Number State | MT
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 10338
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License Number State | MT
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Taxonomy #6
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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