Healthcare Provider Details

I. General information

NPI: 1669062865
Provider Name (Legal Business Name): KALISPELL REGIONAL MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SUNNYVIEW LN STE 103
KALISPELL MT
59901-3128
US

IV. Provider business mailing address

210 SUNNYVIEW LN STE 103
KALISPELL MT
59901-3128
US

V. Phone/Fax

Practice location:
  • Phone: 406-257-3872
  • Fax: 406-758-7077
Mailing address:
  • Phone: 406-257-3872
  • Fax: 406-758-7077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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