| Head Sport Em Llc | |
|
980 W Ironwood Dr Ste 206 Coeur D Alene ID 83814-2668 | |
| (208) 512-4334 | |
| Not Available |
| Full Name | Head Sport Em Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 980 W Ironwood Dr Ste 206, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Craig Panos (OWNER) |
| Authorized Official Contact | 2085124334 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Head Sport Em Llc 980 W Ironwood Dr Ste 206 Coeur D Alene ID 83814-2668 Ph: () - | Head Sport Em Llc 980 W Ironwood Dr Ste 206 Coeur D Alene ID 83814-2668 Ph: (208) 512-4334 |
| NPI Number | 1194598102 |
|---|---|
| Provider Enumeration Date | 11/01/2023 |
| Last Update Date | 11/01/2023 |
| Medicare PECOS PAC ID | 4486097862 |
|---|---|
| Medicare Enrollment ID | O20240213002990 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194598102 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
| Provider Name | Craig J Panos |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1104855188 PECOS PAC ID: 9830136886 Enrollment ID: I20071121000518 |
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