is a Health Service in Coeur D Alene, Idaho. practices all healthcare services and medical treatments related to Health Service. The NPI Number for is 1699932509. The last update date is .
's current location address is 1617 Lincoln Way, Coeur D Alene, Idaho. You can contact this provider via phone number 2086645000 and fax number 2086678098. The mailing address for is 1617 Lincoln Way, Coeur D Alene, Idaho. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 1617 Lincoln Way, Coeur D Alene, Idaho |
| Phone Number | 2086645000 |
| Fax Number | 2086678098 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1699932509 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 1617 Lincoln Way |
|---|---|
| City | Coeur D Alene |
| State | Idaho (ID) |
| Post Code | 838142422 |
| Phone Number | 2086645000 |
| Fax Number | 2086678098 |
Provider's Primary Taxonomy Detail
| Speciality | Health Service |
|---|---|
| Taxonomy | 261Qh0100X |
| Licence No | CHIA469 |
|
Definition: Provides general outpatient medical care by physicians and other providers. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| C4694 | ID | BLUE CROSS | |
| 31546 | ID | REGENCE BLUE SHIELD |
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