Healthcare Provider Details

I. General information

NPI: 1982657466
Provider Name (Legal Business Name): HEALTHCENTER NORTHWEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/27/2023
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 WINDWARD WAY SUITE 101
KALISPELL MT
59901-3133
US

IV. Provider business mailing address

245 WINDWARD WAY SUITE 101
KALISPELL MT
59901-3133
US

V. Phone/Fax

Practice location:
  • Phone: 406-756-8488
  • Fax: 406-257-1443
Mailing address:
  • Phone: 406-756-8488
  • Fax: 406-257-1443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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