Provider Demographics
NPI:1275231797
Name:THE PINK TENT, LLC
Entity Type:Organization
Organization Name:THE PINK TENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-498-0511
Mailing Address - Street 1:670 S FERGUSON AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6493
Mailing Address - Country:US
Mailing Address - Phone:406-551-2178
Mailing Address - Fax:
Practice Address - Street 1:670 S FERGUSON AVE STE 2A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6493
Practice Address - Country:US
Practice Address - Phone:406-551-2178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies