Basic Information
| Provider Information | |||||||||
| NPI: | 1629138797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHARP | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 HIGHLAND BLVD | ||||||||
| Address2: | ATTN PFS CREDENTIALING COORDINATOR | ||||||||
| City: | BOZEMAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597156902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064145000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 931 HIGHLAND BLVD STE 3260 | ||||||||
| Address2: | |||||||||
| City: | BOZEMAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597156907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064142410 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 07/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 9861 | ND | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 8367 | MT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 273412 | 01 | MT | MEDICARE HARRISON RHC | OTHER | 0720122 | 05 | MT | MEDICAID | P00157188 | 01 | ND | RAILROAD MEDICARE | OTHER | 273402 | 01 | MT | MEDICARE RHC | OTHER |