1427243971 NPI number — KALISPELL REGINAL MEDICAL CENTER

Table of content: (NPI 1427243971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427243971 NPI number — KALISPELL REGINAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALISPELL REGINAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE CLINIC AT WAL-MART BY KRMC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427243971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CONWAY DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901-3112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-212-4886
Provider Business Mailing Address Fax Number:
406-257-2010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 HUTTON RANCH ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALISPELL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59937-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-751-6533
Provider Business Practice Location Address Fax Number:
406-257-2010
Provider Enumeration Date:
09/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STJOHN
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
FNP
Authorized Official Telephone Number:
406-751-6533

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  19254 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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