NPIMap

Organization Active NPI

Glacier Surgical Center, LLC

Doing business as Rocky Mountain Surgical Suites

  • Ambulatory Surgical Clinic/Center
  • Kalispell, MT
National Provider Identifier
1881461705
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
GLACIER SURGICAL CENTER, LLC
Doing business as
Rocky Mountain Surgical Suites
Practice address
1400 Pondera Street
Kalispell, MT 59901
Phone
(406) 250-4847
NPI assigned
Dec 11, 2023
Last updated
Nov 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Authorized official

Name
Kyle Tubbs, MDNPI 1487818944
Title
Medical Director
Phone
(406) 756-6887

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

1400 Pondera Street
Kalispell, MT 59901

Mailing address

1400 Pondera Street
Kalispell, MT 59901
Phone (406) 250-4847

Other names 1

  • Rocky Mountain Surgical Suites Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240301001173 MT Part B Supplier - Ambulatory Surgical Center 7012352909 Practice locations: Kalispell, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881461705. Details of each certification follow.

Ambulatory surgical center certification: CCN 27C0001104

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
ROCKY MOUNTAIN SURGICAL SUITES
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Oct 4, 2024
Last certification
Oct 4, 2024
Ownership / control type
Proprietary
Facility address
1400 Pondera Street
Kalispell, MT 59901

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
27D2297984Glacier Surgical Center, LLC1400 Pondera Street, Kalispell, MT 59901Certificate of waiverJan 24, 2028

National Provider Directory

National Provider Directory

Locations

1400 Pondera St
Kalispell, MT 59901
Phone (406) 250-4847

Practitioners & affiliated clinicians

Practitioners 7

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": "1702252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1881461705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 PONDERA STREET",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "59901",
            "telephone_number": "406-250-4847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 PONDERA STREET",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "59901",
            "telephone_number": "406-250-4847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIER SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-11",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "TUBBS",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "406-756-6887",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rocky Mountain Surgical Suites",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rocky Mountain Surgical Suites",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kalispell, MT

Sources for this page

Verify at the official NPI Registry.