# KOOTENAI HEALTH, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kootenai Clinics Cancer Services Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073835591
- **Authorized official:** JON NESS (CEO)
- **Authorized official phone:** (208) 625-5081

## Contact information

- **Practice address:** 700 W IRONWOOD DR, COEUR D ALENE, ID 83814-2656
- **Practice address phone:** (208) 625-5670
- **Practice address fax:** (208) 625-5669
- **Mailing address:** 700 W IRONWOOD DR, STE 228, COEUR D ALENE, ID 83814-2656
- **Mailing address phone:** (208) 625-5670
- **Mailing address fax:** (208) 625-5669

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0002X | Clinic Pharmacy | 1198LS | ID | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 02/25/2010
- **Last updated:** 01/05/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1073835591 | — | ID |
| 01 | — | 2124398 | PK | — |