Healthcare Provider Details

I. General information

NPI: 1184011561
Provider Name (Legal Business Name): HEALTHCENTER NORTHWEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 11/27/2023
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CLAREMONT ST SUITE A
KALISPELL MT
59901-3585
US

IV. Provider business mailing address

75 CLAREMONT ST SUITE A
KALISPELL MT
59901-3585
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-8282
  • Fax:
Mailing address:
  • Phone: 406-752-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number8752
License Number StateMT

VIII. Authorized Official

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