FMG West Lacrosse Avenue Idaho LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FMG WEST LACROSSE AVENUE IDAHO LLC

Practice address

210 W Lacrosse Ave
Coeur D Alene, ID 83814-2403

Phone

(208) 664-2185

Fax

(208) 664-1604

NPI assigned

Dec 24, 2014

Last updated

Nov 7, 2017By 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

David C. Keating

Title

Secretary Agent

Phone

(414) 908-8058

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1419379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510012800000",
    "number": "1811385974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5001 WEST LEMON STREET",
            "address_2": "C/O FOCUS MANAGEMENT GROUP",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336091103",
            "telephone_number": "813-281-0062",
            "fax_number": "813-281-0063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W LACROSSE AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142403",
            "telephone_number": "208-664-2185",
            "fax_number": "208-664-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMG WEST LACROSSE AVENUE IDAHO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-24",
        "last_updated": "2017-11-07",
        "status": "A",
        "authorized_official_last_name": "KEATING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "SECRETARY AGENT",
        "authorized_official_telephone_number": "414-908-8058"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Marie Floyd, LMSW
• Richard Andrew Flygare, P.A.-C.
• Patrick W Flynn, CRNA
• Tia A Flynn, AUD
• FMG Ironwood Place Idaho LLC
• Deanna M Fofanoff, LCPC
• Shana D Fogarty, M.D.
• Miranda Caroline Foley-Kekauoha, DOULA
• Gretchen Foley, PA-C
• Martina Folowell Nix

• Skilled Nursing Facility in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Skilled Nursing Facility in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2017; 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.