Bozeman Clinic PLLP
Organization Active NPI Family Medicine Physician · Bozeman, MT
NPI 1013936244 · NPPES record last updated Jan 4, 2019
Key facts
- NPI
- 1013936244
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- BOZEMAN CLINIC PLLP
- Practice address
- 931 Highland Blvd
Suite 3360
Bozeman, MT 59715 - Phone
- (406) 587-4242
- Fax
- (406) 587-3507
- NPI assigned
- Jul 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Judith J. Douglas, BSN, RN
- Title
- Administrator
- Phone
- (406) 587-4242
Practitioners 8
-
Gabor Benda, MD
-
Steven G Roberts, DO
-
Matthew Harrison, MD
-
Jeremy J Waters, M.D.
-
Kara R Waters, D.O
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050713000334 | MT | Part B Supplier - Clinic/Group Practice | 2264468180 |
Receives reassigned benefits from 8 practitioners Practice locations: Bozeman, MT |
National Provider Directory
Locations
931 Highland Blvd
#3360B
Bozeman, MT 59715
Phone (406) 587-4242
1245 N 15th Ave
Bozeman, MT 59715
Phone (406) 587-4242
931 Highland Blvd
Ste 3360
Bozeman, MT 59715
Phone (406) 414-5300
Interoperability endpoints
- https://api.platform.athenahealth.com/18402/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
931 Highland Blvd
Suite 3360
Bozeman, MT 59715
Mailing address
931 Highland Blvd
Suite 3360
Bozeman, MT 59715
Phone (406) 587-4242
Other providers in Bozeman, MT
- Kevin Wayne Bozarth
- Bozeman Birth Center
- Bozeman Birth Center
- Bozeman Chiropractic & Acupuncture Clinic Inc
- Bozeman Chiropractic Clinic, LLC
- Bozeman Counseling Center PLLC
- Bozeman Creek Family Health, PLLC
- Bozeman Denture Center, PLLC
- Bozeman Diagnostics LLC
- Bozeman Dialysis Center
All providers in Bozeman, MT · Family Medicine Physician in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.