Provider Demographics
NPI:1578857124
Name:GO FIGURE MONTANA LLC
Entity Type:Organization
Organization Name:GO FIGURE MONTANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ADVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:406-868-2941
Mailing Address - Street 1:300 PARK DR S STE 202
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-1819
Mailing Address - Country:US
Mailing Address - Phone:406-799-4990
Mailing Address - Fax:
Practice Address - Street 1:125 NORTHWEST BYP
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-4141
Practice Address - Country:US
Practice Address - Phone:406-727-5673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAPN18532132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Single Specialty