| Bozeman Primary Care | |
|
4535 Valley Commons Dr Ste 104 Bozeman MT 59718-4160 | |
| (406) 404-1525 | |
| Not Available |
| Full Name | Bozeman Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 4535 Valley Commons Dr Ste 104, Bozeman, Montana |
| Authorized Official Name and Position | Terry Scott Edwards (OWNER) |
| Authorized Official Contact | 4064041525 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bozeman Primary Care 4535 Valley Commons Dr Ste 104 Bozeman MT 59718-4160 Ph: (406) 404-1525 | Bozeman Primary Care 4535 Valley Commons Dr Ste 104 Bozeman MT 59718-4160 Ph: (406) 404-1525 |
| NPI Number | 1477020824 |
|---|---|
| Provider Enumeration Date | 10/24/2018 |
| Last Update Date | 06/17/2019 |
| Medicare PECOS PAC ID | 3971836479 |
|---|---|
| Medicare Enrollment ID | O20190617001053 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477020824 | NPI | - | NPPES |
| 8210759 | Medicaid | MT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Terry S Edwards |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811912991 PECOS PAC ID: 7618936279 Enrollment ID: I20041008000206 |
| Provider Name | Melissa N Blixt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588179873 PECOS PAC ID: 5193086593 Enrollment ID: I20180227002951 |
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