RATHDRUM CLINIC, INC. (NPI# 1538503693) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538503693 |
| Entity Type | Organization |
| Organization Name | RATHDRUM CLINIC, INC. |
| Other Organization Name | RESTORED HORIZONS |
| Practice Address |
14775 N Kimo Ct Ste C Rathdrum ID 83858-8762 |
| Mailing Address |
2115 E Sherman Ave Suite 101 Coeur D Alene ID 83814-5362 |
| Practice Telephone | 2088197103 |
| Practice Fax Number | 2087633203 |
| Mailing Telephone | 2088197103 |
| Mailing Fax Number | 2087633203 |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2019-06-06 |
| Authorized Official Name | MICHAEL WHITING (OWNER) |
| Authorized Official Telephone | 2088197103 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
M8126 | ID | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Restored Horizons | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 913 W Canfield Ave, Coeur D Alene, ID 838159764 | 2088197103 | 2087633203 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669572780 | Rathdrum Clinic, Inc. | Family Medicine | 14775 N Kimo Ct, Suite B, Rathdrum, ID 83858-8762 | 2006-09-25 |
| Street Address |
14775 N KIMO CT STE C |
| City | RATHDRUM |
| State | ID |
| Zip Code | 83858-8762 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174183578 | Kerri Ruddell | Nurse Practitioner | 16760 Id-41, Rathdrum, ID 83858 | 2019-06-18 |
| 1811555758 | Daniel Whitesitt | Dentist | 14596 Id-41, Rathdrum, ID 83858 | 2019-06-05 |
| 1831437839 | Patricia M Salois | Speech-Language Pathologist | 1564 Washington Street, Rathdrum, ID 83858 | 2013-01-25 |
| 1063554673 | Lakeland Joint School Disrict #272 | Local Education Agency (LEA) | 1564 Washington Ave, Rathdrum, ID 83858 | 2007-02-12 |
| 1275695140 | James M Mcnamara | Dentist | 13997 W Hwy 53, Rathdrum, ID 83858 | 2006-12-15 |
| 1568573962 | Chad Stephen Devore | Dentist | 14596 Hwy 41, Suite A, Rathdrum, ID 83858 | 2006-08-31 |
| 1811982994 | Frances L. White | Contractor | 14528 N Wight St, Rathdrum, ID 83858 | 2005-09-15 |
| 1578061883 | Ann N Moffett | Nurse Practitioner | 858 Commerce Dr., Smelterville, ID 83858 | 2018-02-01 |
| 1063055069 | Karin Sue Duncan | Naturopath | 16726 N Meadowview Ln, Rathdrum, ID 83858-0017 | 2019-10-22 |
| 1770768624 | Gabrielle Durbin | Private Vehicle | W 7164 Diagonal, Rathdrum, ID 83858-0283 | 2008-01-09 |
| Find all providers in zip 83858 | ||||
| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629101928 | David Reed Hadlock | Family Medicine | 496 C Shoup Ave W, Twin Falls, ID 83301-4563 | 2007-03-14 |
| 1801450259 | Recovery Refuge Counseling Center, LLC | Family Medicine | 8100 W Emerald St Ste 180, Boise, ID 83704-9069 | 2019-04-30 |
| 1982037727 | Jon-eric Baillie, Md Pllc | Family Medicine | 8100 W Emerald St Ste 180, Boise, ID 83704 | 2013-08-15 |
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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.