Healthcare Provider Details

I. General information

NPI: 1770948929
Provider Name (Legal Business Name): KALISPELL FOOT & ANKLE CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 VILLAGE LOOP RD
KALISPELL MT
59901-2793
US

IV. Provider business mailing address

58 VILLAGE LOOP RD
KALISPELL MT
59901-2793
US

V. Phone/Fax

Practice location:
  • Phone: 406-755-5250
  • Fax: 406-755-5251
Mailing address:
  • Phone: 406-755-5250
  • Fax: 406-755-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN WEBB
Title or Position: PODIATRIST
Credential: DPM
Phone: 406-755-5250