Kootenai Urgent Care LLC
Organization Active NPI Family Medicine Physician · Post Falls, ID
NPI 1629392154 · NPPES record last updated Mar 22, 2012
Key facts
- NPI
- 1629392154
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- KOOTENAI URGENT CARE LLC
- Practice address
- 1300 E Mullan Ave
Suite 600
Post Falls, ID 83854-6052 - Phone
- (208) 777-9110
- Fax
- (208) 777-1871
- NPI assigned
- Mar 26, 2010
- Organization subpart
- No
Authorized official
- Name
- Eric Koelsch
- Title
- Executive Director
- Phone
- (208) 676-0145
Other NPIs on the same Medicare enrollment 3
Member of 2
Member organizations 2
Practitioners 11
-
Robin Marie Beard, ARNP
-
Bradley P Bowman, M.D.
-
Sandra Kay Kibler, CFNP
-
Christian Menard, M.D., PH.D.
-
Jennie Hoke, PA-C
-
Kerri Ruddell, NP
-
Kate Aguirre, M.D.
-
Robert L Zurcher, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100621000358 | ID | Part B Supplier - Clinic/Group Practice | 1052441946 |
Receives reassigned benefits from 35 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Coeur D Alene, ID; Post Falls, ID |
National Provider Directory
Locations
700 W Ironwood Dr
Ste 220E
Coeur D Alene, ID 83814
700 W Ironwood Dr
Ste 272E
Coeur D Alene, ID 83814
Phone (208) 667-4557
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
1300 E Mullan Ave
Suite 600
Post Falls, ID 83854-6052
Mailing address
700 W Ironwood Dr
Suite 272E
Coeur D Alene, ID 83814-2656
Phone (208) 676-0145
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1369049 | Other | ID | MEDICARE PART B PTAN |
| DQ3168 | Other | ID | RAILROAD MEDICARE |
Other providers in Post Falls, ID
- Kaitlyn Rose Koons
- Kootenai County
- Kootenai Health, Inc.
- Kootenai Kids Pediatrics PLLC
- Kootenai Prosthetic Orthotic Services Inc
- Nathan Christopher Kubej
- Laboratory Corporation of America
- Laboratory Corporation of America
- Laboratory Corporation of America
- Laboratory Corporation of America
All providers in Post Falls, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.