Organization Name: | FIELD OF DREAMS PC |
NPI Number: | 1447244140 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN MICHAEL WISE (DIRECTOR) |
Mailing Address: | 1006 W Main St Bozeman |
State: | MT US |
Postal Code: | 597153219 |
Phone Number: | 4065868711 |
Fax Number: | 4065872602 |
NPI Enumeration Date: | 09/08/2005 |
NPI Last Update Date: | 10/27/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 4048 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |