Provider Demographics
NPI:1912945544
Name:KALISPELL REGIONAL MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:KALISPELL REGIONAL MEDICAL CENTER, INC
Other - Org Name:LOGAN HEALTH SURGERY CENTER - KALISPELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-752-1724
Mailing Address - Street 1:111 SUNNYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3164
Mailing Address - Country:US
Mailing Address - Phone:406-257-6700
Mailing Address - Fax:406-257-3612
Practice Address - Street 1:111 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3164
Practice Address - Country:US
Practice Address - Phone:406-257-6700
Practice Address - Fax:406-257-3612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KALISPELL REGIONAL MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-04
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10908261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0030615Medicaid
000005713Medicare PIN
MT0030615Medicaid