Coeur D'Alene Surgical and Vein

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

M-7963 Issued in ID

Legal business name

COEUR D'ALENE SURGICAL AND VEIN

Practice address

608 Northwest Blvd
Suite 301
Coeur D Alene, ID 83814-2174

Phone

(208) 664-4940

Fax

(208) 664-5345

NPI assigned

Jan 6, 2010

Last updated

Mar 20, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kevin M Johnson, M.D.NPI 1679685598

Title

Managing Member

Phone

(208) 664-4940

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Kevin M Johnson, MD

  • Surgery Physician
  • Coeur d'Alene, ID
  • NPI 1679685598
  Authorized official Same address or phone

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

{
    "created_epoch": "1262736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363737600000",
    "number": "1225368632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 NORTHWEST BLVD",
            "address_2": "SUITE 301",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142174",
            "telephone_number": "208-664-4940",
            "fax_number": "208-664-5345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 NORTHWEST BLVD",
            "address_2": "SUITE 301",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142174",
            "telephone_number": "208-664-4940",
            "fax_number": "208-664-5345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COEUR D'ALENE SURGICAL AND VEIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-06",
        "last_updated": "2013-03-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "208-664-4940",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "ID",
            "license": "M-7963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coeur D'Alene OB/GYN, PA
• Coeur D'Alene Partners, LLC Dba Creekside Inn Assisted Living Alz Comm
• Coeur D'Alene Pediatrics PA
• Coeur D'Alene School District #271
• Coeur D'Alene Surgery Center Inc
• Coeur D'Alene Wigs LLC
• Coeur Dalene Vision Source
• Coeur Obstetrics and Gynecology, PLLC
• Coeur Therapeutics JJ (Coeur Therapeutics)
• Coeur Vitality PLLC

• Medical Specialty Clinic/Center in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Medical Specialty Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; 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.