NPIMap

Organization Active NPI

Jacqueline S. Wilson, M.D., P.C.

  • Adult Mental Health Clinic/Center
  • Bozeman, MT
National Provider Identifier
1194822049
Registry record updated Mar 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
8315 Issued in MT
Legal business name
JACQUELINE S. WILSON, M.D., P.C.
Practice address
321 E Main St
Suite 309
Bozeman, MT 59715-6241
Phone
(406) 586-7515
Fax
(406) 522-0481
NPI assigned
Sep 20, 2006
Last updated
Mar 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacqueline S. Wilson, M.D.NPI 1568403640
Title
President
Phone
(406) 586-7515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 8315 MT Primary

Addresses

Primary practice location

321 E Main St
Suite 309
Bozeman, MT 59715-6241

Mailing address

321 E Main St
Suite 309
Bozeman, MT 59715-6241
Phone (406) 586-7515

Other identifiers 2

IdentifierTypeStateIssuer
0152425MedicaidMT
93296OtherMTBCBS

National Provider Directory

National Provider Directory

Locations

321 E Main St
Ste 309
Bozeman, MT 59715
Phone (406) 586-7515

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205712000000",
    "number": "1194822049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 E MAIN ST",
            "address_2": "SUITE 309",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597156241",
            "telephone_number": "406-586-7515",
            "fax_number": "406-522-0481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 E MAIN ST",
            "address_2": "SUITE 309",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597156241",
            "telephone_number": "406-586-7515",
            "fax_number": "406-522-0481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUELINE S. WILSON, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-03-17",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "406-586-7515",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MT",
            "license": "8315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0152425",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "93296",
            "state": "MT"
        }
    ],
    "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 Mar 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.