Provider Demographics
NPI:1891151122
Name:KALISPELL REGIONAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:KALISPELL REGIONAL MEDICAL CENTER INC
Other - Org Name:GLACIER ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-752-1724
Mailing Address - Street 1:75 CLAREMONT ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3585
Mailing Address - Country:US
Mailing Address - Phone:406-752-7600
Mailing Address - Fax:
Practice Address - Street 1:75 CLAREMONT ST
Practice Address - Street 2:SUITE E
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3585
Practice Address - Country:US
Practice Address - Phone:406-752-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8025207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty