Provider Demographics
NPI:1477638732
Name:ELKHORN MOUNTAIN CYTOLOGY LLC
Entity Type:Organization
Organization Name:ELKHORN MOUNTAIN CYTOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-442-5001
Mailing Address - Street 1:21 N LAST CHANCE GULCH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4199
Mailing Address - Country:US
Mailing Address - Phone:406-442-5001
Mailing Address - Fax:406-442-4438
Practice Address - Street 1:21 N LAST CHANCE GULCH ST STE 205
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4199
Practice Address - Country:US
Practice Address - Phone:406-442-5001
Practice Address - Fax:406-442-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT27D0966466291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0420427Medicaid
MT27D0966466OtherCLIA ID NUMBER
MT27D0966466OtherCLIA ID NUMBER