Provider Demographics
NPI:1972870103
Name:GINA NELSON M.D. PC
Entity Type:Organization
Organization Name:GINA NELSON M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OBSTETRICIAN GYNECOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-755-6550
Mailing Address - Street 1:1297 BURNS WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:406-755-6563
Practice Address - Street 1:1297 BURNS WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3128
Practice Address - Country:US
Practice Address - Phone:406-755-6550
Practice Address - Fax:406-755-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7570207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0104338Medicaid
MT0104338Medicaid
MT010000766Medicare PIN