| Kootenai Physicians Clinic | |
|
2003 Kootenai Health Way Coeur D Alene ID 83814-6051 | |
| (208) 625-4000 | |
| Not Available |
| Full Name | Kootenai Physicians Clinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2003 Kootenai Health Way, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Jon Ness (CEO) |
| Authorized Official Contact | 2086255081 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kootenai Physicians Clinic 2003 Kootenai Health Way Coeur D Alene ID 83814-6051 Ph: (208) 625-4000 | Kootenai Physicians Clinic 2003 Kootenai Health Way Coeur D Alene ID 83814-6051 Ph: (208) 625-4000 |
| NPI Number | 1174661151 |
|---|---|
| Provider Enumeration Date | 02/02/2007 |
| Last Update Date | 01/05/2024 |
| Certification Date | 11/03/2023 |
| Medicare PECOS PAC ID | 4789641598 |
|---|---|
| Medicare Enrollment ID | O20120227000210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174661151 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 282N00000X | General Acute Care Hospital | 42 (Idaho) | Secondary |
| Provider Name | Lawrence J Derbes |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1902906787 PECOS PAC ID: 3072506005 Enrollment ID: I20230515002650 |
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