KOOTENAI HEALTH (NPI# 1699807743) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699807743 |
| Entity Type | Organization |
| Organization Name | KOOTENAI HEALTH |
| Other Organization Name | KOOTENAI MEDICAL CENTER ONCOLOGY GROUP |
| Practice Address |
2003 Kootenai Health Way Coeur D Alene ID 83814-6051 |
| Practice Telephone | 2086254000 |
| Practice Fax Number | 2086255731 |
| Mailing Telephone | 2086254000 |
| Mailing Fax Number | 2086255731 |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2015-09-25 |
| Authorized Official Name | JON D. NESS (CEO) |
| Authorized Official Telephone | 2086254000 |
| Is Organization Subpart | Y |
| Parent Organization Name | KOOTENAI HEALTH |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
42 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 805712000 | 05 | |
| ID | REGENCE BLUE SHIELD | 000010004927 | 01 |
| ID | BLUE CROSS | 83758 | 01 |
| Other Name | Type Code |
|---|---|
| Kootenai Medical Center Oncology Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194345199 | Kootenai Health | Durable Medical Equipment & Medical Supplies | 700 W Ironwood Dr Ste 159, Coeur D Alene, ID 83814-4401 | 2020-04-20 |
| 1205113784 | Kootenai Health | Internal Medicine | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2011-11-10 |
| 1700918851 | Kootenai Health | Radiology | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2007-03-12 |
| 1174661151 | Kootenai Health | General Acute Care Hospital | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2007-02-02 |
| 1609925023 | Kootenai Health | Durable Medical Equipment & Medical Supplies | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2007-01-09 |
| 1235288655 | Kootenai Health | Neurological Surgery | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2007-01-09 |
| 1316096738 | Kootenai Health | Counselor | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2007-01-09 |
| 1659476455 | Kootenai Health | Rehabilitation Unit | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2006-09-14 |
| 1568567360 | Kootenai Health | Psychiatric Unit | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2006-09-14 |
| 1992798409 | Kootenai Health | General Acute Care Hospital | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2005-08-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | KOOTENAI HEALTH | 2003 Kootenai Health Wy, Coeur D Alene, ID 83814-6051 |
| Street Address |
2003 KOOTENAI HEALTH WAY |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83814-6051 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912909151 | Pamela S Pomeroy | Nurse Practitioner | 2003 Kootenai Health Way, Coeur D Alene, ID 83814 | 2005-06-01 |
| 1104425149 | Denise White | Nurse Practitioner | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2020-10-21 |
| 1992343487 | Audrey Nordness | Pharmacist | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-12-15 |
| 1881245017 | Jackie Rae Fitting | Pharmacist | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-29 |
| 1336790567 | Shane Oliver Withers Jr. | Pharmacist | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-29 |
| 1447800552 | Keith Mccullough | Physician Assistant | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-19 |
| 1568012102 | Kaitlin Wendt | Nurse Practitioner | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-16 |
| 1215586862 | Heather A Hamilton | Social Worker | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-06 |
| 1205498193 | Guy Hoenke | Registered Nurse | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-07-01 |
| 1407417843 | Maddison M Ray | Dietitian, Registered | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-06-26 |
| Find all providers in the same location | ||||
| 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 | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356607485 | Paul S White | Internal Medicine | 700 W Ironwood Dr Ste 130, Coeur D Alene, ID 83814 | 2012-04-03 |
| 1437326980 | Kootenai Medical Center | Internal Medicine | 2003 Lincoln Way, Coeur D Alene, ID 83814-2611 | 2008-05-14 |
| 1720202724 | Brian L Samuels Md Pllc | Internal Medicine | 700 W Ironwood Dr, Coeur D Alene, ID 83814-2656 | 2007-04-12 |
| 1689768848 | Kevin T. Kim | Internal Medicine | 700 W Ironwood Dr, Suite 130, Coeur D Alene, ID 83814-2656 | 2006-10-03 |
| 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 |
|---|---|---|---|---|
| 1891857512 | Nathan Bradley Adams | Internal Medicine | 2330 Desoto St, Idaho Falls, ID 83404-7570 | 2006-12-16 |
| 1669565669 | A. Richard Miranda | Internal Medicine | 706 N College Rd, Suite A, Twin Falls, ID 83301-5824 | 2006-10-02 |
| 1528075744 | Thomas J Leavitt | Internal Medicine | 284 Buck Run, Sagle, ID 83860 | 2006-08-01 |
| 1669497194 | Dane J Dickson | Internal Medicine | 380 Walker Drive, Rexburg, ID 83440 | 2006-07-13 |
| 1588696538 | Jonathan N Swerdloff | Internal Medicine | 308 E Hawaii Ave, Nampa, ID 83686-6013 | 2006-07-07 |
| 1508809252 | Daniel E Williams | Internal Medicine | 1250 Idaho St, Lewiston, ID 83501-1965 | 2006-06-13 |
| 1871558239 | Michael L Francisco | Internal Medicine | 651 Memorial Dr, Portneuf Cancer Center, Pocatello, ID 83201 | 2006-04-19 |
| 1669462362 | Mountain View Hospital LLC | Internal Medicine | 2325 Coronado St, Idaho Falls, ID 83404-7407 | 2005-10-24 |
| 1952307605 | David W. Ririe | Internal Medicine | 500 S 11th Ave Ste 100, Pocatello, ID 83201-4877 | 2005-06-27 |
| 1477020303 | Maria Teresa Cervantes-fullmer | Internal Medicine | 3245 Channing Way, Idaho Falls, ID 83404-7536 | 2018-10-29 |
| Find all providers with the same taxonomy | ||||
| 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.