Provider Demographics
NPI:1306262803
Name:COTTONWOOD CLINIC, LLC
Entity type:Organization
Organization Name:COTTONWOOD CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NP
Authorized Official - Prefix:
Authorized Official - First Name:HEIDE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:406-846-4275
Mailing Address - Street 1:310 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-1000
Mailing Address - Country:US
Mailing Address - Phone:406-846-4275
Mailing Address - Fax:406-846-7278
Practice Address - Street 1:310 MAIN ST
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-1000
Practice Address - Country:US
Practice Address - Phone:406-846-4275
Practice Address - Fax:406-846-7278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT25000363LF0000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty