Healthcare Provider Details

I. General information

NPI: 1730183609
Provider Name (Legal Business Name): CITY OF KALISPELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 1ST AVE E
KALISPELL MT
59901-4936
US

IV. Provider business mailing address

PO BOX 1997
KALISPELL MT
59903-1997
US

V. Phone/Fax

Practice location:
  • Phone: 406-758-7760
  • Fax: 406-758-7777
Mailing address:
  • Phone: 406-758-7760
  • Fax: 406-758-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number018
License Number StateMT

VIII. Authorized Official

Name: DAVID DEDMAN
Title or Position: FIRE CHIEF
Credential:
Phone: 406-758-7760