Provider Demographics
NPI:1770994139
Name:FLATHEAD VALLEY ORTHOPEDIC CENTER, P.C.
Entity type:Organization
Organization Name:FLATHEAD VALLEY ORTHOPEDIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-752-7900
Mailing Address - Street 1:111 SUNNYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3164
Mailing Address - Country:US
Mailing Address - Phone:406-752-7900
Mailing Address - Fax:406-257-0253
Practice Address - Street 1:710 E 13TH ST
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2981
Practice Address - Country:US
Practice Address - Phone:406-862-8045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLATHEAD VALLEY ORTHOPEDIC CENTER, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000008430Medicare PIN