Organization
SURGICAL ASSOCIATES OF BOZEMAN, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY L BANKS M.D. (VICE-PRESIDENT)
(406) 587-0704
Entity
Organization
Contact information
Practice address
925 HIGHLAND BOULEVARD, SUITE 1200, BOZEMAN, MT 59715-6900
(406) 587-0704
(406) 587-1147
Mailing address
925 HIGHLAND BOULEVARD, SUITE 1200, BOZEMAN, MT 59715-6900
(406) 587-0704
(406) 587-1147
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
15264
MT
208600000X
Surgery Physician
10338
MT
208600000X
Surgery Physician
4000
MT
208600000X
Surgery Physician
6438
MT
208600000X
Surgery Physician
9898
MT
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000037700
—
MT
05
—
000048568
—
MT
05
—
000062917
—
MT
05
—
000085748
—
MT
Enumeration date
03/07/2007
Last updated
08/22/2011
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