NPIMap

Organization Active NPI

Glacier Dermatology PC

  • Dermatology Physician
  • Kalispell, MT
National Provider Identifier
1407366545
Registry record updated Dec 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
10806 Issued in MT
Legal business name
GLACIER DERMATOLOGY PC
Practice address
40 Four Mile Dr Ste 7
Kalispell, MT 59901-2655
Phone
(406) 314-6336
NPI assigned
Oct 3, 2017
Last updated
Dec 12, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sylvia A Owen, MDNPI 1366500464
Title
Physician/Owner
Phone
(406) 314-6336

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU
Dermatology Physician 207N00000X 10806 MT Primary

Addresses

Primary practice location

40 Four Mile Dr Ste 7
Kalispell, MT 59901-2655

Mailing address

40 Four Mile Dr Ste 7
Kalispell, MT 59901-2655
Phone (406) 314-6336

Other identifiers 1

IdentifierTypeStateIssuer
0143741MedicaidMT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513036800000",
    "number": "1407366545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 FOUR MILE DR STE 7",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599012655",
            "telephone_number": "406-314-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 FOUR MILE DR STE 7",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599012655",
            "telephone_number": "406-314-6336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIER DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-03",
        "last_updated": "2017-12-12",
        "status": "A",
        "authorized_official_last_name": "OWEN",
        "authorized_official_first_name": "SYLVIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "406-314-6336",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MT",
            "license": "10806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0143741",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalispell, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.