DR. KEITH D BORTNEM (NPI# 1255372959) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255372959 |
| Entity Type | Individual |
| Full Name | DR. KEITH D BORTNEM |
| Credential | D.O. |
| Practice Address |
1401 25th St S Great Falls MT 59405-5183 |
| Mailing Address |
500 15th Ave S Suite 1 Great Falls MT 59405-4324 |
| Practice Telephone | 4064553650 |
| Practice Fax Number | 4064553695 |
| Mailing Telephone | 4064553650 |
| Mailing Fax Number | 4064553695 |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2019-07-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204C00000X | Neuromusculoskeletal Medicine, Sports Medicine | 7067 | MT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MT | RAILROAD MEDICARE | 200012385 | 01 |
| MT | EBMS | 810347861003 | 01 |
| BLUE CROSS BLUE SHIELD | 000003721 | 01 | |
| MT | CHAMPUS | 810347861 | 01 |
| MT | 0094796 | 05 | |
| WASHINGTON L&I | 0206209 | 01 |
| Street Address |
1401 25TH ST S |
| City | GREAT FALLS |
| State | MT |
| Zip Code | 59405-5183 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184625055 | Mary E Gray | Nurse Practitioner | 1401 25th St S, Great Falls, MT 59405-5183 | 2005-08-02 |
| 1104459718 | Katie Grace Smyth | Physician Assistant | 1401 25th St S, Great Falls, MT 59405-5183 | 2020-02-21 |
| 1962973776 | Blanche Stutz | Nurse Practitioner | 1401 25th St S, Great Falls, MT 59405-5183 | 2018-12-06 |
| 1457828337 | Zale Kaupish | Physician Assistant | 1401 25th St S, Great Falls, MT 59405-5183 | 2018-10-29 |
| 1245722735 | Jordan Elizabeth Hronek | Physician Assistant | 1401 25th St S, Great Falls, MT 59405-5183 | 2018-05-31 |
| 1164932000 | Alyissa H Canady | Pharmacist | 1401 25th St S, Great Falls, MT 59405-5183 | 2017-10-05 |
| 1417466327 | Margaret Janelle Davenport | Physician Assistant | 1401 25th St S, Great Falls, MT 59405-5183 | 2017-09-22 |
| 1588183321 | Andrew Koopman | Physician Assistant | 1401 25th St S, Great Falls, MT 59405-5183 | 2017-09-13 |
| 1306364724 | Noelle Marie-lynn Steiner | Physician Assistant | 1401 25th St S, Great Falls, MT 59405-5183 | 2017-09-06 |
| 1982121760 | Melanie Marie Brown | Nurse Practitioner | 1401 25th St S, Great Falls, MT 59405-5183 | 2017-08-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902446180 | Reilly Kunz | Physical Therapist | 2621 15th Ave South, Great Falls, MT 59405 | 2020-01-15 |
| 1336617224 | Brandi Noel Sauer | Behavior Technician | 1601 2nd Ave North Suite 518, Great Falls, MT 59405 | 2018-11-08 |
| 1982103446 | Traci Raines Aprn Pllc | Nurse Practitioner | 120 Marillyn Dr, Great Falls, MT 59405 | 2018-02-09 |
| 1003332818 | Great Falls Health Supplies | Durable Medical Equipment & Medical Supplies | 1720 10th Ave., South, Suite 4-151, Great Falls, MT 59405 | 2017-08-15 |
| 1518489426 | Jessica Lynn Keller | Specialist/Technologist | 720 46th Street South, Great Falls, MT 59405 | 2017-07-12 |
| 1235678475 | Vanessa Claudia Hernandez | Occupational Therapist | 2621 15 Ave So, Great Falls, MT 59405 | 2017-02-21 |
| 1871039339 | Morgan Laux Olsen | Specialist/Technologist | 1301 20th St S, Great Falls, MT 59405 | 2017-01-09 |
| 1558807198 | Greg Robert Lipton | Occupational Therapist | 2621 15th Ave So, Great Falls, MT 59405 | 2017-01-06 |
| 1386180925 | Jessica Lee Krahn | Physical Therapist | 2621 15th Ave So., Great Falls, MT 59405 | 2017-01-06 |
| 1811430150 | Juli Brandvold | Massage Therapist | 2400 4th Ave S., Great Falls, MT 59405 | 2016-11-18 |
| Find all providers in zip 59405 | ||||
| Taxonomy Code | 204C00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neuromusculoskeletal Medicine, Sports Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427127927 | Peter Valentine Teal | Neuromusculoskeletal Medicine, Sports Medicine | 2950 Walden Pl, Billings, MT 59102-0944 | 2006-11-07 |
| 1083698740 | William Carl Anderson | Neuromusculoskeletal Medicine, Sports Medicine | 281 N. 17th Avenue, Forsyth, MT 59327-0410 | 2005-12-05 |
| 1881680510 | Erik Stuart Adams | Neuromusculoskeletal Medicine, Sports Medicine | 117 E Oak St Ste 1a, Bozeman, MT 59715 | 2005-09-27 |
| 1407043474 | Charles B Anderson Md PC | Neuromusculoskeletal Medicine, Sports Medicine | 301 Saddle Dr, Helena, MT 59601-8098 | 2007-10-03 |
| 1235286915 | Charles Bradley Anderson | Neuromusculoskeletal Medicine, Sports Medicine | 301 Saddle Dr, Helena, MT 59601-8098 | 2007-01-04 |
| 1306926795 | Family Health Care PC | Neuromusculoskeletal Medicine, Sports Medicine | 1287 Burns Way, Kalispell, MT 59901-3109 | 2006-10-17 |
| 1376522888 | Robert J Seim | Neuromusculoskeletal Medicine, Sports Medicine | 2360 Mullan Rd, Suite C, Missoula, MT 59808-1811 | 2006-01-12 |
| 1396724159 | Christopher Ralph Price | Neuromusculoskeletal Medicine, Sports Medicine | 2360 Mullan Rd, Suite C, Missoula, MT 59808-1811 | 2006-01-11 |
| City | GREAT FALLS |
| Zip Code | 59405 |
Please comment or provide details below to improve the information on DR. KEITH D BORTNEM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.