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Organization
NORTH IDAHO ENDOSCOPY CENTER PLLC
Active
Organization
NORTH IDAHO ENDOSCOPY CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAVIN S YOUNG M.D. (MEDICAL DIRECTOR)
(208) 665-9184
Entity
Organization
Contact information
Practice address
1607 LINCOLN WAY SUITE 100, COEURDALENE, ID 83814-2476
(208) 665-9184
(208) 665-7964
Mailing address
1607 LINCOLN WAY SUITE 100, COEURDALENE, ID 83814-2476
(208) 665-9184
(208) 665-7964
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010138610
REGENCE BLUE SHIELD
ID
01
—
04358
BLUE CROSS
ID
01
—
23856
GROUP HEALTH
ID
01
—
490005464
RR MEDICARE
ID
05
—
806363500
—
ID
Enumeration date
06/29/2005
Last updated
12/29/2011
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