Provider Demographics
NPI:1740728583
Name:THE GOLGI CLINIC, LLC
Entity type:Organization
Organization Name:THE GOLGI CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:406-360-9123
Mailing Address - Street 1:113 W FRONT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4332
Mailing Address - Country:US
Mailing Address - Phone:406-541-8886
Mailing Address - Fax:
Practice Address - Street 1:113 W FRONT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4332
Practice Address - Country:US
Practice Address - Phone:406-541-8886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care