Healthcare Provider Details

I. General information

NPI: 1194100248
Provider Name (Legal Business Name): KALISPELL REGIONAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SUNNYVIEW LN STE 101
KALISPELL MT
59901-3128
US

IV. Provider business mailing address

210 SUNNYVIEW LN STE 101
KALISPELL MT
59901-3128
US

V. Phone/Fax

Practice location:
  • Phone: 406-751-8009
  • Fax: 406-257-6463
Mailing address:
  • Phone: 406-751-8009
  • Fax: 406-257-6463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NW0100X
TaxonomyWomen's Hospital
License NumberNUR-RN-LIC-78174
License Number StateMT

VIII. Authorized Official

Name: VELINDA STEVENS
Title or Position: CEO, PRESIDENT
Credential:
Phone: 406-752-5111