Provider Demographics
NPI:1235165838
Name:GLACIER EAR NOSE AND THROAT HEAD AND NECK SURGERY PC
Entity Type:Organization
Organization Name:GLACIER EAR NOSE AND THROAT HEAD AND NECK SURGERY PC
Other - Org Name:GLACIER HEARING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-752-8330
Mailing Address - Street 1:160 HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-752-8330
Mailing Address - Fax:406-752-8412
Practice Address - Street 1:160 HERITAGE WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-752-8330
Practice Address - Fax:406-752-8412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1102770001Medicare NSC