NPIMap

Organization Active NPI

Suzanne C Gullotta

Doing business as Lakeside Family Health Center

  • Family Nurse Practitioner
  • Somers, MT
National Provider Identifier
1699872010
Registry record updated Jan 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
020838 Issued in MT
Legal business name
SUZANNE C GULLOTTA
Doing business as
Lakeside Family Health Center
Practice address
77 Deer Creek Road
Somers, MT 59932
Phone
(406) 857-2997
NPI assigned
Sep 20, 2006
Last updated
Jan 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Suzanne C Gullotta, NPNPI 1962401372
Title
Owner
Phone
(406) 857-2997

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 020838 MT Primary

Addresses

Primary practice location

77 Deer Creek Road
Somers, MT 59932

Mailing address

PO Box 649
Lakeside, MT 59922-0649
Phone (406) 857-2997

Other identifiers 2

IdentifierTypeStateIssuer
037108OtherMTBCBS
0434707MedicaidMT

Other names 1

  • Lakeside Family Health Center Doing business as

National Provider Directory

National Provider Directory

Locations

100 Bierney Creek Rd
Lakeside, MT 59922
Phone (406) 844-2997

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200614400000",
    "number": "1699872010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 649",
            "city": "LAKESIDE",
            "state": "MT",
            "postal_code": "599220649",
            "telephone_number": "406-857-2997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 DEER CREEK ROAD",
            "city": "SOMERS",
            "state": "MT",
            "postal_code": "59932",
            "telephone_number": "406-857-2997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUZANNE C GULLOTTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-01-18",
        "status": "A",
        "authorized_official_last_name": "GULLOTTA",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-857-2997",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MT",
            "license": "020838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "037108",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0434707",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Somers, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.