Organization Active NPI

Conveniencecare Clinic

  • Nurse Practitioner
  • Bozeman, MT
National Provider Identifier
1639374382
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN9447 Issued in MT
Legal business name
CONVENIENCECARE CLINIC
Practice address
2419 W Main St Ste 2
Bozeman, MT 59718-3813
Phone
(406) 922-2750
Fax
(406) 922-2751
NPI assigned
Jun 20, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Marykay Thurston, FNP
Title
Owner
Phone
(406) 922-2750

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN9447 MT Primary

Addresses

Primary practice location

2419 W Main St Ste 2
Bozeman, MT 59718-3813

Mailing address

2419 W Main St Ste 2
Bozeman, MT 59718-3813
Phone (406) 922-2750

Other identifiers 1

IdentifierTypeStateIssuer
4308344MedicaidMT

National Provider Directory

National Provider Directory

Locations

2419 W Main St
Ste 2
Bozeman, MT 59718
Phone (406) 922-2750

Practitioners & affiliated clinicians

Practitioners 1

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": "1182297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639374382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2419 W MAIN ST STE 2",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597183813",
            "telephone_number": "406-922-2750",
            "fax_number": "406-922-2751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2419 W MAIN ST STE 2",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597183813",
            "telephone_number": "406-922-2750",
            "fax_number": "406-922-2751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVENIENCECARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THURSTON",
        "authorized_official_first_name": "MARYKAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-922-2750",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MT",
            "license": "RN9447",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4308344",
            "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 Aug 22, 2020; 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.