NPIMap

Organization Active NPI

Kootenai Health, Inc.

Doing business as Kootenai Clinics Cancer Services Pharmacy

  • Clinic Pharmacy
  • Coeur d'Alene, ID
National Provider Identifier
1073835591
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
1198LS Issued in ID
Legal business name
KOOTENAI HEALTH, INC.
Doing business as
Kootenai Clinics Cancer Services Pharmacy
Practice address
700 W Ironwood Dr
Coeur D Alene, ID 83814-2656
Phone
(208) 625-5670
Fax
(208) 625-5669
NPI assigned
Feb 25, 2010
Last updated
Jan 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jon Ness
Title
Ceo
Phone
(208) 625-5081

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Clinic Pharmacy 3336C0002X 1198LS ID Primary
Specialty Pharmacy 3336S0011X NU

Addresses

Primary practice location

700 W Ironwood Dr
Coeur D Alene, ID 83814-2656

Mailing address

700 W Ironwood Dr
Ste 228
Coeur D Alene, ID 83814-2656
Phone (208) 625-5670

Other identifiers 2

IdentifierTypeStateIssuer
1073835591MedicaidID
2124398OtherPK

Other names 1

  • Kootenai Clinics Cancer Services Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kootenai Health14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1267056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1073835591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR",
            "address_2": "STE 228",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142656",
            "telephone_number": "208-625-5670",
            "fax_number": "208-625-5669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142656",
            "telephone_number": "208-625-5670",
            "fax_number": "208-625-5669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOTENAI HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-25",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "NESS",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-625-5081"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "ID",
            "license": "1198LS",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073835591",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2124398",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kootenai Clinics Cancer Services Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.