Provider Demographics
NPI:1275247876
Name:FLATHEAD PAIN & REGENERATIVE HEALTH LLC
Entity Type:Organization
Organization Name:FLATHEAD PAIN & REGENERATIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOMMER
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-385-1931
Mailing Address - Street 1:80 FOUR MILE DR STE 16
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2665
Mailing Address - Country:US
Mailing Address - Phone:406-314-4095
Mailing Address - Fax:
Practice Address - Street 1:80 FOUR MILE DR STE 16
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2665
Practice Address - Country:US
Practice Address - Phone:406-314-4095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center