# BOZEMAN SKIN CLINIC PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275701351
- **Authorized official:** MR. JOHN R TKACH MD (PRESIDENT)
- **Authorized official phone:** (406) 587-5442

## Contact information

- **Practice address:** 300 N WILLSON AVE, SUITE 203B, BOZEMAN, MT 59715-3551
- **Practice address phone:** (406) 587-5442
- **Mailing address:** 300 N WILLSON AVE, SUITE 203B, BOZEMAN, MT 59715-3551
- **Mailing address phone:** (406) 587-5442

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 3871 | MT | Yes |

## Other

- **Enumeration date:** 02/12/2008
- **Last updated:** 04/22/2013