Healthcare Provider Details

I. General information

NPI: 1518412303
Provider Name (Legal Business Name): HEALTHCENTER NORTHWEST, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 11/27/2023
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SUNNYVIEW LN
KALISPELL MT
59901
US

IV. Provider business mailing address

320 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number18743
License Number StateMT

VIII. Authorized Official

Name: WILLIAM D GIBSON
Title or Position: GENERAL COUNSEL
Credential:
Phone: 406-752-1724