Provider Demographics
NPI:1659328276
Name:KALISPELL REGIONAL RADIATION ONCOLOGY PC
Entity Type:Organization
Organization Name:KALISPELL REGIONAL RADIATION ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:P.
Authorized Official - Middle Name:
Authorized Official - Last Name:TOTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-837-0683
Mailing Address - Street 1:PO BOX 7653
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-0653
Mailing Address - Country:US
Mailing Address - Phone:406-837-0683
Mailing Address - Fax:
Practice Address - Street 1:343 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3156
Practice Address - Country:US
Practice Address - Phone:406-751-1790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT104672085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT84691Medicare ID - Type Unspecified