Provider Demographics
NPI:1619292901
Name:MTINK
Entity Type:Organization
Organization Name:MTINK
Other - Org Name:GREEN BEAN COFFEESHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SILVERNALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-544-7873
Mailing Address - Street 1:2710 BROOKS ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7868
Mailing Address - Country:US
Mailing Address - Phone:406-544-7873
Mailing Address - Fax:
Practice Address - Street 1:2710 BROOKS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7868
Practice Address - Country:US
Practice Address - Phone:406-544-7873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site