Healthcare Provider Details

I. General information

NPI: 1932141603
Provider Name (Legal Business Name): KALISPELL MEDICAL OFFICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 BURNS WAY
KALISPELL MT
59901-3110
US

IV. Provider business mailing address

1280 BURNS WAY
KALISPELL MT
59901-3110
US

V. Phone/Fax

Practice location:
  • Phone: 406-755-5266
  • Fax: 406-755-0228
Mailing address:
  • Phone: 406-755-5266
  • Fax: 406-755-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MARISE K JOHNSON
Title or Position: OWNER
Credential: M.D.
Phone: 406-755-5266