Provider Demographics
NPI:1982657466
Name:HEALTHCENTER NORTHWEST LLC
Entity Type:Organization
Organization Name:HEALTHCENTER NORTHWEST LLC
Other - Org Name:THE MONTANA CENTER FOR WELLNESS AND PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-752-1724
Mailing Address - Street 1:245 WINDWARD WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3133
Mailing Address - Country:US
Mailing Address - Phone:406-756-8488
Mailing Address - Fax:406-257-1443
Practice Address - Street 1:245 WINDWARD WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3133
Practice Address - Country:US
Practice Address - Phone:406-756-8488
Practice Address - Fax:406-257-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000084831Medicare PIN