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NPI Code Detail

MEDICARE: MONTANA SKIN CANCER AND DERMATOLOGY CENTER, P.C.

MEDICARE: MONTANA SKIN CANCER AND DERMATOLOGY CENTER, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician20664MT

General Provider Information

NPI Number : 1487082087
Entity Type Code : Organization
Provider Name (Legal Business Name) : MONTANA SKIN CANCER AND DERMATOLOGY CENTER, P.C.
Provider Business Mailing Address
First Line : 1905 W COLLEGE ST
Second Line :
City : BOZEMAN
State : MT
Zip : 59718-4061
Country : US
Telephone Number : 406-587-4432
Fax Number : 406-587-7015
Provider Business Practice Location Address
First Line : 1905 W COLLEGE ST
Second Line :
City : BOZEMAN
State : MT
Zip : 59718-4061
Country : US
Telephone Number : 406-587-4432
Fax Number : 406-587-7015
Authorized Official
Title or Position : BILLING MANAGER
Name : JENNIFER RAASCH
Credential : CPB
Telephone Number : 406-587-4432
Provider Enumeration Date : 10/17/2013
Last Update Date : 03/08/2023

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