Basic Information
| Provider Information | |||||||||
| NPI: | 1053905570 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KALISPELL REGIONAL MEDICAL CENTER, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LOGAN HEALTH NEWMAN CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 CLAREMONT ST STE C | ||||||||
| Address2: | |||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599013500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067585155 | ||||||||
| FaxNumber: | 4067585166 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 CLAREMONT ST STE C | ||||||||
| Address2: | |||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599013500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067585155 | ||||||||
| FaxNumber: | 4067585166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2021 | ||||||||
| LastUpdateDate: | 03/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | GIBSON | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 4067521724 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.