Organization
BOHANNON CREEK ENTERPRISES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON H. LUCAS CRNA (PRESIDENT)
(503) 372-2740
Entity
Organization
Contact information
Practice address
90 HIGHWAY 91 SOUTH, DILLON, MT 59725-3516
(406) 683-3000
Mailing address
PO BOX 34940, SEATTLE, WA 98124-1940
(503) 372-2740
(503) 372-2754
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4302037
—
MT
Enumeration date
07/14/2006
Last updated
08/22/2020
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