COEUR D'ALENE SURGICAL AND VEIN (NPI# 1225368632) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225368632 |
| Entity Type | Organization |
| Organization Name | COEUR D'ALENE SURGICAL AND VEIN |
| Practice Address |
608 Northwest Blvd Suite 301 Coeur D Alene ID 83814-2174 |
| Practice Telephone | 2086644940 |
| Practice Fax Number | 2086645345 |
| Mailing Telephone | 2086644940 |
| Mailing Fax Number | 2086645345 |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2013-03-20 |
| Authorized Official Name | DR. KEVIN M JOHNSON (MANAGING MEMBER) |
| Authorized Official Telephone | 2086644940 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
M-7963 | ID | Ambulatory Health Care Facilities |
| Street Address |
608 NORTHWEST BLVD SUITE 301 |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83814-2174 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720190796 | John P Lundeby | Surgery | 608 Northwest Blvd, Suite 301, Coeur D Alene, ID 83814-2174 | 2006-08-31 |
| 1679685598 | Kevin M Johnson | Surgery | 608 Northwest Blvd, Suite 301, Coeur D Alene, ID 83814-2174 | 2006-08-31 |
| 1043322811 | Laser and Vein Center Pllc | Surgery | 608 Northwest Blvd, Suite 301, Coeur D Alene, ID 83814-2174 | 2006-08-31 |
| 1659483410 | Lake City Surgeons Pllc | Surgery | 608 Northwest Blvd, Suite 301, Coeur D Alene, ID 83814-2174 | 2006-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477162675 | Dehra Mcfaddan | Social Worker | 211 E. Coeur D'alene Ave, 102, Coeur D Alene, ID 83814 | 2020-07-24 |
| 1043838634 | Yendi Labelle | Nurse Practitioner | 1115 N Ironwood Drive, Coeur D'alene, ID 83814 | 2020-07-09 |
| 1295353217 | Cultivation, LLC | Counselor | 211 E. Coeur Dalene Ave. Ste 102, Coeur D'alene, ID 83814 | 2020-07-07 |
| 1306487517 | Northwest Integrated Health, LLP | Clinic/Center | 1250 West N. Northwood Center Ct, Suite B, Coeur D'alene, ID 83814 | 2019-09-30 |
| 1730740465 | Connor Williams | Physical Therapist | 1812 W Lakewood Dr, Ste. 100, Coeur D Alene, ID 83814 | 2019-06-24 |
| 1912480153 | Nadine M Lewis | Social Worker | 211 E. Coeur D'alene Ave., Coeur D'alene, ID 83814 | 2018-09-13 |
| 1992208631 | Orthopedic Surgery and Sports | Orthopaedic Surgery | 1812 N Lakewood Drive, Suite 100, Coeur D'alene, ID 83814 | 2018-03-08 |
| 1346758042 | Heather Marie Johnson | Counselor | 7905 Meadowlark Way, Cda, ID 83814 | 2018-01-16 |
| 1881113413 | Brevity Treatment Services | Counselor | 2201 N. Government Way Ste. L, Coeur D'alene, ID 83814 | 2017-09-14 |
| 1366969628 | Jennifer La Gina Highfield | Massage Therapist | 1104 N Ste B, Coeur D Alene, ID 83814 | 2017-08-28 |
| Find all providers in zip 83814 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
| 1902366834 | Pain & Spine Consultants | Clinic/Center | 1344 Hiland Avenue, Ste A, Burley, ID 83318 | 2019-03-25 |
| 1982015822 | Kenneth C Romney Md Inc | Clinic/Center | 526 Shoup Ave W Ste E, Twin Falls, ID 83301-5050 | 2014-05-14 |
| 1588802391 | Alpine Dermatology Clinic P.C. | Clinic/Center | 1049 Summers Dr, Rexburg, ID 83440-5335 | 2009-02-02 |
| 1275715559 | Dr. James D. Tanner, D.c., P.a. | Clinic/Center | 6070 E Sagewood Dr, Idaho Falls, ID 83406-5077 | 2007-11-29 |
| 1023201084 | St Lukes Regional Medical Center | Clinic/Center | 100 E Idaho St Ste 200, Boise, ID 83712-6270 | 2007-08-23 |
| 1750371894 | David N. Sim, M.d.,p.a. | Clinic/Center | 6014 W Emerald St, Boise, ID 83704-8855 | 2005-10-27 |
| 1740812320 | Back To Health Chiropractic LLC | Clinic/Center | 60 S 2nd W, Rexburg, ID 83440-1819 | 2020-02-11 |
| 1265903736 | Poole Joint Replacement Specialists | Clinic/Center | 2365 E Gala St Ste 1, Meridian, ID 83642-4881 | 2018-12-10 |
| 1891104014 | Idaho Joint and Spine, PC | Clinic/Center | 9510 W Fairview Ave, Boise, ID 83704-8103 | 2014-08-13 |
| 1477897726 | James Rex Cutler Dpm Pllc | Clinic/Center | 76 E 1st S, Rexburg, ID 83440-1936 | 2012-11-26 |
| Find all providers with the same taxonomy | ||||
| City | COEUR D ALENE |
| Zip Code | 83814 |
Please comment or provide details below to improve the information on COEUR D'ALENE SURGICAL AND VEIN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.