| North Idaho Ketamine & Tms | |
|
250 Northwest Blvd Ste 200 Coeur D Alene ID 83814-2973 | |
| (208) 215-1568 | |
| Not Available |
| Full Name | North Idaho Ketamine & Tms |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 250 Northwest Blvd Ste 200, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Maxine Mcelree (CFO) |
| Authorized Official Contact | 2084465127 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Idaho Ketamine & Tms 250 Northwest Blvd Ste 200 Coeur D Alene ID 83814-2973 Ph: (208) 215-1568 | North Idaho Ketamine & Tms 250 Northwest Blvd Ste 200 Coeur D Alene ID 83814-2973 Ph: (208) 215-1568 |
| NPI Number | 1619344637 |
|---|---|
| Provider Enumeration Date | 08/25/2015 |
| Last Update Date | 11/04/2024 |
| Certification Date | 11/04/2024 |
| Medicare PECOS PAC ID | 2062802630 |
|---|---|
| Medicare Enrollment ID | O20211214002475 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619344637 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 0101258812 (Virginia) | Primary |
| 261QP3300X | Clinic/center - Pain | (* (Not Available)) | Secondary |
| Provider Name | John Michael Thurston |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144664848 PECOS PAC ID: 4082916309 Enrollment ID: I20200811003185 |
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