Bozeman Skin Clinic Professional Corporation

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

3871 Issued in MT

Legal business name

BOZEMAN SKIN CLINIC PROFESSIONAL CORPORATION

Practice address

300 N Willson Ave
Suite 203B
Bozeman, MT 59715-3551

Phone

(406) 587-5442

NPI assigned

Feb 12, 2008

Organization subpart

No

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

Authorized official

Name

Mr. John R Tkach, MD

Title

President

Phone

(406) 587-5442

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1202774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366588800000",
    "number": "1275701351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 N WILLSON AVE",
            "address_2": "SUITE 203B",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597153551",
            "telephone_number": "406-587-5442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N WILLSON AVE",
            "address_2": "SUITE 203B",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597153551",
            "telephone_number": "406-587-5442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOZEMAN SKIN CLINIC PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-12",
        "last_updated": "2013-04-22",
        "status": "A",
        "authorized_official_last_name": "TKACH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "406-587-5442",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MT",
            "license": "3871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Bozeman, MT
• Providers in Bozeman, MT by specialty
• Medical Specialty Clinic/Center in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2013; 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.