Healthcare Provider Details

I. General information

NPI: 1467690396
Provider Name (Legal Business Name): MEDNORTH KALISPELL URGENT CARE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 US HIGHWAY 93 N
KALISPELL MT
59901-2547
US

IV. Provider business mailing address

PO BOX 10338
KALISPELL MT
59904-3338
US

V. Phone/Fax

Practice location:
  • Phone: 406-755-5661
  • Fax: 406-755-5674
Mailing address:
  • Phone: 406-755-5661
  • Fax: 406-755-5674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANE ALAN HILL
Title or Position: OWNER
Credential: M.D.
Phone: 406-871-0267