Healthcare Provider Details

I. General information

NPI: 1114243367
Provider Name (Legal Business Name): PARADYME ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 BROOKS ST STE 2
MISSOULA MT
59801-7868
US

IV. Provider business mailing address

2710 BROOKS ST STE 2
MISSOULA MT
59801-7868
US

V. Phone/Fax

Practice location:
  • Phone: 406-541-3465
  • Fax:
Mailing address:
  • Phone: 406-541-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. PHAEDRUS HEMPHILL SWAB
Title or Position: OWNER
Credential:
Phone: 406-541-3465