Provider Demographics
NPI:1427612845
Name:BOZEMAN HEALTH DEACONESS HOSPITAL
Entity type:Organization
Organization Name:BOZEMAN HEALTH DEACONESS HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:LUDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-414-1036
Mailing Address - Street 1:915 HIGHLAND BLVD STE 2170
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6902
Mailing Address - Country:US
Mailing Address - Phone:406-414-5552
Mailing Address - Fax:
Practice Address - Street 1:935 HIGHLAND BLVD STE 2200
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6915
Practice Address - Country:US
Practice Address - Phone:406-414-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty