BEACON CANCER CARE PLLC (NPI# 1407335367) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407335367 |
| Entity Type | Organization |
| Organization Name | BEACON CANCER CARE PLLC |
| Practice Address |
980 W Ironwood Dr Ste 207 Coeur D Alene ID 83814 |
| Mailing Address |
980 W Ironwood Dr Ste 207 Coeur D Alene ID 83814-2668 |
| Practice Telephone | 2087552804 |
| Practice Fax Number | 2087650277 |
| Mailing Telephone | 2087552804 |
| Mailing Fax Number | 2087650277 |
| Enumeration Date | 2018-08-11 |
| Last Update Date | 2020-01-08 |
| Authorized Official Name | DR. DAVID CADWELL BARTELS (OWNER) |
| Authorized Official Telephone | 2087752804 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities | ||
| Y | 261QX0200X |
Clinic/Center Specialization: Oncology |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 1407335367 | 05 | |
| WA | 2107483 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 229 S 7th St, St Maries, ID 838611803 | 2087552804 | 2087650277 |
| Street Address |
980 W IRONWOOD DR STE 207 |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83814 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124071592 | Danko Martincic | Internal Medicine | 980 W Ironwood Dr Ste 207, Coeur D Alene, ID 83814-2668 | 2006-05-18 |
| 1649879081 | Grace Suyanti Muliawan | Physician Assistant | 980 W Ironwood Dr Ste 207, Coeur D Alene, ID 83814-2668 | 2020-10-17 |
| 1659692200 | Stephanie Ann Hart | Nurse Practitioner | 980 W Ironwood Dr Ste 207, Coeur D Alene, ID 83814-2668 | 2010-06-17 |
| 1114251378 | Sarah Renee Nave | Dietitian, Registered | 980 W Ironwood Dr Ste 207, Coeur D Alene, ID 83814-2668 | 2009-09-21 |
| 1245492768 | David C Bartels | Internal Medicine | 980 W Ironwood Dr Ste 207, Coeur D Alene, ID 83814-2668 | 2008-06-26 |
| 1346439452 | Eric Charles Schubert | Physician Assistant | 980 W Ironwood Dr Ste 207, Coeur D Alene, ID 83814-2668 | 2007-10-15 |
| 1396776027 | Brian Louis Samuels | Internal Medicine | 980 W Ironwood Dr Ste 207, Coeur D Alene, ID 83814-2668 | 2006-07-05 |
| 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 | 261QX0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oncology |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment and prescriptive services related to cancerous conditions. Services include chemotherapy infusions and monitoring of implanted chemotherapeutic agents. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801945225 | North Idaho Cancer Center | Clinic/Center | 2003 Lincoln Way, Coeur D Alene, ID 83814-2611 | 2007-01-09 |
| City | COEUR D ALENE |
| Zip Code | 83814 |
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| 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.