Organization
KALISPELL DIAGNOSTIC SERVICE INC
Active
Other names
Greater Flathead Renal
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN D LARSON (PRACTICE ADMINISTRATOR)
(406) 752-7582
Entity
Organization
Contact information
Practice address
135 COMMONS WAY, KALISPELL, MT 59901-1900
(406) 752-7406
(406) 752-7544
Mailing address
135 COMMONS WAY, KALISPELL, MT 59901-1900
(406) 752-7406
(406) 752-7544
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8607
BCBS
MT
01
—
C43672
RR MEDICARE
—
Enumeration date
09/21/2006
Last updated
03/04/2014
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