Provider Demographics
NPI:1548583487
Name:KALISPELL REGIONAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:KALISPELL REGIONAL MEDICAL CENTER INC
Other - Org Name:LOGAN HEALTH SURGICAL CLINIC - WHITEFISH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAMBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-752-1724
Mailing Address - Street 1:1111 BAKER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2908
Mailing Address - Country:US
Mailing Address - Phone:406-863-1333
Mailing Address - Fax:406-863-1334
Practice Address - Street 1:1111 BAKER AVE STE 2
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2908
Practice Address - Country:US
Practice Address - Phone:406-863-1333
Practice Address - Fax:406-863-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-07
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12029208600000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty