1932274636 NPI number — KALISPELL REGIONAL MEDICAL CENTER, INC

Table of content: (NPI 1932274636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932274636 NPI number — KALISPELL REGIONAL MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALISPELL REGIONAL MEDICAL CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAKE COUNTY HOME OPTIONS HOSPICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932274636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/31/2007
NPI Reactivation Date:
10/11/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 CORPORATE DR
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901-6037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-751-4200
Provider Business Mailing Address Fax Number:
406-257-0355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 MAIN ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RONAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59864-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-676-7300
Provider Business Practice Location Address Fax Number:
406-676-3606
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HINKLEY
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR HOME OPTIONS
Authorized Official Telephone Number:
406-751-4230

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  9964 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 350250 . This is a "BCBS MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 750125 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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