Healthcare Provider Details

I. General information

NPI: 1235165838
Provider Name (Legal Business Name): GLACIER EAR NOSE AND THROAT HEAD AND NECK SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HERITAGE WAY
KALISPELL MT
59901
US

IV. Provider business mailing address

160 HERITAGE WAY
KALISPELL MT
59901
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-8330
  • Fax: 406-752-8412
Mailing address:
  • Phone: 406-752-8330
  • Fax: 406-752-8412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. KENT R. KEELE
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 406-752-8330