Basic Information
| Provider Information | |||||||||
| NPI: | 1689264129 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KALISPELL REGIONAL MEDICAL CENTER, INC | ||||||||
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| OtherOrganizationName: | LOGAN HEALTH WOMEN'S CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 CLAREMONT ST STE A | ||||||||
| Address2: | |||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599013500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067528282 | ||||||||
| FaxNumber: | 4062572225 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 CLAREMONT ST STE A | ||||||||
| Address2: | |||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599013500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067528282 | ||||||||
| FaxNumber: | 4062572225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2021 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | GIBSON | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 4067521724 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.