Basic Information
| Provider Information | |||||||||
| NPI: | 1174956973 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KALISPELL REGIONAL MEDICAL CENTER INC | ||||||||
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| OtherOrganizationName: | LOGAN HEALTH NEWMAN CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 CLAREMONT ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599013585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067585155 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 CLAREMONT ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599013585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067585155 | ||||||||
| FaxNumber: | 4067585166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2013 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | LAMBRECHT | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4067521724 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.