Healthcare Provider Details

I. General information

NPI: 1386622843
Provider Name (Legal Business Name): GOLD STREET CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 W GOLD ST
BUTTE MT
59701-2319
US

IV. Provider business mailing address

775 W GOLD ST
BUTTE MT
59701-2319
US

V. Phone/Fax

Practice location:
  • Phone: 406-782-9090
  • Fax: 406-782-9191
Mailing address:
  • Phone: 406-782-9090
  • Fax: 406-782-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberRN14014
License Number StateMT

VIII. Authorized Official

Name: MS. SHARON HEALY
Title or Position: OWNER
Credential:
Phone: 406-782-9090