Provider Demographics
NPI:1932274636
Name:KALISPELL REGIONAL MEDICAL CENTER, INC
Entity type:Organization
Organization Name:KALISPELL REGIONAL MEDICAL CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HOME OPTIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HINKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSA
Authorized Official - Phone:406-751-4230
Mailing Address - Street 1:275 CORPORATE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6037
Mailing Address - Country:US
Mailing Address - Phone:406-751-4200
Mailing Address - Fax:406-257-0355
Practice Address - Street 1:711 MAIN ST SW
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-2502
Practice Address - Country:US
Practice Address - Phone:406-676-7300
Practice Address - Fax:406-676-3606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KALISPELL REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-21
Last Update Date:2014-04-25
Deactivation Date:2007-08-31
Deactivation Code:
Reactivation Date:2007-10-11
Provider Licenses
StateLicense IDTaxonomies
MT9964251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT350250OtherBCBS MT
MT750125Medicaid
MT271513Medicare Oscar/Certification