| Organization Name: | LAKESIDE WELLNESS PC |
| NPI Number: | 1306276035 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JILL B RIPLEY (OWNER) |
| Mailing Address: | 77 Deer Cr Rd Suite B Somers |
| State: | MT US |
| Postal Code: | 59932 |
| Phone Number: | 4067553751 |
| Fax Number: | |
| NPI Enumeration Date: | 11/15/2013 |
| NPI Last Update Date: | 11/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | 10172 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |