COEUR D ALENE SPINE AND BRAIN PLLC (NPI# 1588714489) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588714489 |
| Entity Type | Organization |
| Organization Name | COEUR D ALENE SPINE AND BRAIN PLLC |
| Practice Address |
3320 N Grand Mill Ln Coeur D Alene ID 83814-5689 |
| Practice Telephone | 2087659100 |
| Practice Fax Number | 2087659103 |
| Mailing Telephone | 2087659100 |
| Mailing Fax Number | 2087659103 |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2019-11-20 |
| Authorized Official Name | LISA RAE TANSY (ADMINISTRATOR) |
| Authorized Official Telephone | 2087659100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | M8677 | ID | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7116981 | 05 | |
| WASHINGTON L & I | 0172116 | 01 | |
| OWCP | 205112900 | 01 | |
| BLUE CROSS OF IDAHO | 8H195 | 01 | |
| REGENCE BLUESHIELD | 000010143406 | 01 | |
| ID | 806619500 | 05 | |
| MEDICARE RR | DA4210 | 01 | |
| CRIME VICTIMS COMP FUND | 8948154 | 01 |
| Street Address |
3320 N GRAND MILL LN |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83814-5689 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649353947 | Jeffrey J Larson | Neurological Surgery | 3320 N Grand Mill Ln, Coeur D Alene, ID 83814-5689 | 2006-10-23 |
| 1154730968 | Sean Michael Hunter | Specialist/Technologist, Other | 3320 N Grand Mill Ln, Coeur D Alene, ID 83814 | 2014-08-06 |
| 1720493950 | Coeur D Alene | Specialist/Technologist, Other | 3320 N Grand Mill Ln, Coeur D Alene, ID 83814-5689 | 2014-06-26 |
| 1295018968 | Holly Kay Moore | Nurse Practitioner | 3320 N Grand Mill Ln, Coeur D Alene, ID 83814-5689 | 2011-09-20 |
| 1376839191 | Kristi Marie Flicker | Dietitian, Registered | 3320 N Grand Mill Ln, Coeur D Alene, ID 83814-5689 | 2011-06-20 |
| 1518141563 | Patricia A Vieth | Physician Assistant | 3320 N Grand Mill Ln, Coeur D Alene, ID 83814-5689 | 2007-12-27 |
| 1427131721 | Mary H Eggleston Thompson | Physician Assistant | 3320 N Grand Mill Ln, Coeur D Alene, ID 83814-5689 | 2006-10-23 |
| 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 | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740249275 | Daryl K Maccarter | Specialist | 950 W Ironwood Dr, Coeur D Alene, ID 83814-2644 | 2006-03-22 |
| 1326034430 | Jonathan S King | Specialist | 850 W Ironwood Dr Ste 202, Coeur D Alene, ID 83814-4903 | 2005-09-23 |
| 1467448860 | Lloyd E. Witham | Specialist | 1107 W Ironwood Dr, Coeur D Alene, ID 83814-2604 | 2005-09-21 |
| 1174000566 | Timothy Wayne Cork | Specialist | 2201 Ironwood Pl, Coeur D Alene, ID 83814-2670 | 2018-07-27 |
| 1952772196 | Gayle Dohrman | Specialist | 2195 Ironwood Ct, Coeur D Alene, ID 83814-2628 | 2015-10-14 |
| 1740539725 | Gregory R. Keese, M.d., P.C. | Specialist | 1107 W Ironwood Dr, Coeur D Alene, ID 83814-2604 | 2012-09-05 |
| 1619278082 | Kala Marie Moore | Specialist | 852 W Kathleen Ave, Coeur D Alene, ID 83815-9405 | 2010-11-16 |
| 1700107612 | Jill Peterson | Specialist | 6125 N Sunshine St, Coeur D Alene, ID 83815 | 2010-06-15 |
| 1003050527 | Peter C Jones Md Pa | Specialist | 2121 W Ironwood Center Dr, Coeur D Alene, ID 83814-2639 | 2009-04-28 |
| 1013184837 | Maryanne Kleven | Specialist | 500 W Aqua Ave, Coeur D Alene, ID 83815-7764 | 2008-05-12 |
| Find all providers in COEUR D ALENE | ||||
| City | COEUR D ALENE |
| Zip Code | 83814 |
Please comment or provide details below to improve the information on COEUR D ALENE SPINE AND BRAIN PLLC.
| 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.