1518003516 NPI number — NORTH IDAHO CATARACT & LASER CTR

Table of content: (NPI 1518003516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518003516 NPI number — NORTH IDAHO CATARACT & LASER CTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH IDAHO CATARACT & LASER CTR
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:
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:
1518003516
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1814 LINCOLN WAY
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:
83814-2540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-667-2531
Provider Business Mailing Address Fax Number:
208-765-9385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1814 LINCOLN WAY
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:
83814-2540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-667-2531
Provider Business Practice Location Address Fax Number:
208-765-9385
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SINES
Authorized Official First Name:
DEDE
Authorized Official Middle Name:
KAREN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
208-667-2531

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0026786 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1194861278 . This is a "DAVID WOLD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000010004566 . This is a "REGENCE BLUE SHIELD OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1336285345 . This is a "D.JUSTIN STORMOGIPSON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1386780484 . This is a "PATRICK PARDEN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1487790598 . This is a "STEPHEN A MOSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 182044801 . This is a "BLUESHIELD MED ADVANTAGE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 00943 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1538205638 . This is a "RODERICK KENT" identifier . This identifiers is of the category "OTHER".




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