1457696551 NPI number — NORTH IDAHO COLLEGE

Table of content: (NPI 1457696551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457696551 NPI number — NORTH IDAHO COLLEGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH IDAHO COLLEGE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457696551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2120 N LAKEWOOD DR STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COEUR D ALENE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83814-2638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-667-3179
Provider Business Mailing Address Fax Number:
208-667-5938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 N LAKEWOOD DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-2638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-667-3179
Provider Business Practice Location Address Fax Number:
208-667-5938
Provider Enumeration Date:
11/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BOUCHARD
Authorized Official First Name:
PEARL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
208-667-3179

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171W00000X , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 193200000X . This is a "MULTI SPECIALTY" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 251B00000X . This is a "CASE MANAGEMENT" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 171M00000X . This is a "CARE MANAGMENT CARE COORDINATOR" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 251V00000X . This is a "VOLUNTARY OR CHARITABLE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com