MEDICARE: COTTONWOOD CLINIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	25000	MT
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1306262803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTONWOOD CLINIC, LLC

Provider Business Mailing Address
First Line	:	310 MAIN ST
Second Line	:
City	:	DEER LODGE
State	:	MT
Zip	:	59722-1000
Country	:	US
Telephone Number	:	406-846-4275
Fax Number	:	406-846-7278

Provider Business Practice Location Address
First Line	:	310 MAIN ST
Second Line	:
City	:	DEER LODGE
State	:	MT
Zip	:	59722-1000
Country	:	US
Telephone Number	:	406-846-4275
Fax Number	:	406-846-7278

Authorized Official
Title or Position	:	OWNER, NP
Name	:	HEIDE LYNN APPLEGATE
Credential	:	FNP-C
Telephone Number	:	406-846-4275

Provider Enumeration Date	:	03/10/2014
Last Update Date	:	03/12/2024

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Directions to “COTTONWOOD CLINIC, LLC ” Practice Location

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