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NPI Code Detail

MEDICARE: EAST LAKESIDE CLINIC

MEDICARE: EAST LAKESIDE CLINIC
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
1261QP2300XPrimary Care Clinic/Center10172MT

General Provider Information

NPI Number : 1639552235
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST LAKESIDE CLINIC
Provider Business Mailing Address
First Line : 7935 MT HWY 35 STE 201
Second Line :
City : BIGFORK
State : MT
Zip : 59911
Country : US
Telephone Number : 406-837-4357
Fax Number :
Provider Business Practice Location Address
First Line : 7935 MT HIGHWAY 35 STE 201
Second Line :
City : BIGFORK
State : MT
Zip : 59911-5711
Country : US
Telephone Number : 406-837-4357
Fax Number :
Authorized Official
Title or Position : ONWER
Name : MS. JILL B RIPLEY
Credential : FNP
Telephone Number : 406-755-3751
Provider Enumeration Date : 07/01/2015
Last Update Date : 07/01/2015

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Directions to “EAST LAKESIDE CLINIC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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