Healthcare Provider Details

I. General information

NPI: 1972720811
Provider Name (Legal Business Name): KALISPELL GASTROENTEROLOGY,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CLAREMONT ST SUITE F
KALISPELL MT
59901-3585
US

IV. Provider business mailing address

75 CLAREMONT ST SUITE F
KALISPELL MT
59901-3585
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-7441
  • Fax: 406-257-0304
Mailing address:
  • Phone: 406-752-7441
  • Fax: 406-257-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG A HARRISON
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 406-752-7441