Organization Name: | LAKESIDE CLINIC P.C. |
NPI Number: | 1053665091 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JILL B RIPLEY (OWNER) |
Mailing Address: | 77 Deer Creek Rd Somers |
State: | MT US |
Postal Code: | 599328000 |
Phone Number: | 4068572997 |
Fax Number: | 4068572044 |
NPI Enumeration Date: | 10/30/2012 |
NPI Last Update Date: | 05/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |