Provider Demographics
NPI:1114243367
Name:PARADYME ENTERPRISES, LLC
Entity Type:Organization
Organization Name:PARADYME ENTERPRISES, LLC
Other - Org Name:GREEN BEAN COFFEESHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHAEDRUS
Authorized Official - Middle Name:HEMPHILL
Authorized Official - Last Name:SWAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-541-3465
Mailing Address - Street 1:2710 BROOKS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7868
Mailing Address - Country:US
Mailing Address - Phone:406-541-3465
Mailing Address - Fax:
Practice Address - Street 1:2710 BROOKS ST STE 2
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7868
Practice Address - Country:US
Practice Address - Phone:406-541-3465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site