Active NPI
Ita M Killeen, MD
- Family Medicine Physician
- Bozeman, MT
National Provider Identifier
1013082932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 9565
- Practice address
- Swingle Student Health Service South 7TH Ave
Msu
Bozeman, MT 59715-3260 - Phone
- (406) 994-2311
- NPI assigned
- Nov 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 9565 | MT | Primary |
Addresses
Primary practice location
Swingle Student Health Service South 7TH Ave
Msu
Bozeman, MT 59715-3260
Mailing address
Swingle Student Health Service South 7TH Ave
PO Box 173260
Bozeman, MT 59715-3260
Phone (406) 994-2311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9565 | MT | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013082932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "SWINGLE STUDENT HEALTH SERVICE SOUTH 7TH AVE",
"address_2": "PO BOX 173260",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597153260",
"telephone_number": "406-994-2311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "SWINGLE STUDENT HEALTH SERVICE SOUTH 7TH AVE",
"address_2": "MSU",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597153260",
"telephone_number": "406-994-2311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILLEEN",
"first_name": "ITA",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MT",
"license": "9565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bozeman, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.