| Kootenai Medical Center Nibh Group | |
|
2003 Kootenai Health Way Coeur D Alene ID 83814-6051 | |
| (208) 625-4000 | |
| Not Available |
| Full Name | Kootenai Medical Center Nibh Group |
|---|---|
| Speciality | Counselor |
| Location | 2003 Kootenai Health Way, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Jon Ness (CEO) |
| Authorized Official Contact | 2086255081 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kootenai Medical Center Nibh Group 2003 Kootenai Health Way Coeur D Alene ID 83814-6051 Ph: (208) 625-4000 | Kootenai Medical Center Nibh Group 2003 Kootenai Health Way Coeur D Alene ID 83814-6051 Ph: (208) 625-4000 |
| NPI Number | 1316096738 |
|---|---|
| Provider Enumeration Date | 01/09/2007 |
| Last Update Date | 01/05/2024 |
| Certification Date | 01/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316096738 | NPI | - | NPPES |
| E0997 | Other | ID | BLUE CROSS |
| 83758 | Other | ID | BLUE CROSS |
| 000010018067 | Other | ID | REGENCE BLUE SHIELD |
| 805712000 | Medicaid | ID | |
| CG7380 | Other | ID | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 42 (Idaho) | Primary |
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