Basic Information
| Provider Information | |||||||||
| NPI: | 1801840780 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KALISPELL REGIONAL MEDICAL CENTER INC | ||||||||
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| OtherOrganizationName: | LOGAN HEALTH EMERGENCY PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 SUNNYVIEW LANE | ||||||||
| Address2: | |||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599013129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067525111 | ||||||||
| FaxNumber: | 4062572010 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 SUNNYVIEW LANE | ||||||||
| Address2: | |||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599013129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067525111 | ||||||||
| FaxNumber: | 4062572010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 06/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | LAMBRECHT | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4067521724 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | N | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care | 207P00000X | 11474 | MT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.