| Coeur D Alene Primary Care Pllc | |
|
920 W Ironwood Dr Ste 200 Coeur D Alene ID 83814-2643 | |
| (208) 667-2600 | |
| (208) 625-2051 |
| Full Name | Coeur D Alene Primary Care Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 920 W Ironwood Dr Ste 200, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Brandon Rice (OWNER) |
| Authorized Official Contact | 2086672600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coeur D Alene Primary Care Pllc 920 W Ironwood Dr Ste 200 Coeur D Alene ID 83814-2643 Ph: (208) 667-2600 | Coeur D Alene Primary Care Pllc 920 W Ironwood Dr Ste 200 Coeur D Alene ID 83814-2643 Ph: (208) 667-2600 |
| NPI Number | 1922431360 |
|---|---|
| Provider Enumeration Date | 08/20/2013 |
| Last Update Date | 12/29/2022 |
| Medicare PECOS PAC ID | 8729216171 |
|---|---|
| Medicare Enrollment ID | O20140111000034 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922431360 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 363A00000X | Physician Assistant | PA-431 (Idaho) | Secondary |
| Provider Name | Christy L Sutton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457622078 PECOS PAC ID: 5597905042 Enrollment ID: I20130708000089 |
| Provider Name | Robert Jordan Lakko |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174756340 PECOS PAC ID: 2062648132 Enrollment ID: I20151007000620 |
| Provider Name | Patricia Ann Woods |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558032300 PECOS PAC ID: 6103218532 Enrollment ID: I20220117000357 |
| Provider Name | Mckenzie H Gale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578233714 PECOS PAC ID: 4486031689 Enrollment ID: I20220509001908 |
| Provider Name | Zachary Daniel Harman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427725092 PECOS PAC ID: 7618320508 Enrollment ID: I20240126002402 |
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