MEDICARE: KALISPELL REGIONAL MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0206X	Pediatric Gastroenterology Physician	18743	MT
2	2080P0202X	Pediatric Cardiology Physician	40780	MT
3	208000000X	Pediatrics Physician	40780	MT

General Provider Information

NPI Number	:	1154785822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALISPELL REGIONAL MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	202 CONWAY DR STE 200
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3153
Country	:	US
Telephone Number	:	844-215-7969
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 CONWAY DR STE 200
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3153
Country	:	US
Telephone Number	:	844-215-7969
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	CLINTON SEGER
Credential	:	MD
Telephone Number	:	406-752-1724

Provider Enumeration Date	:	04/08/2016
Last Update Date	:	03/19/2026

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