# COEUR D'ALENE SURGICAL AND VEIN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225368632
- **Authorized official:** DR. KEVIN M JOHNSON M.D. (MANAGING MEMBER)
- **Authorized official phone:** (208) 664-4940

## Contact information

- **Practice address:** 608 NORTHWEST BLVD, SUITE 301, COEUR D ALENE, ID 83814-2174
- **Practice address phone:** (208) 664-4940
- **Practice address fax:** (208) 664-5345
- **Mailing address:** 608 NORTHWEST BLVD, SUITE 301, COEUR D ALENE, ID 83814-2174
- **Mailing address phone:** (208) 664-4940
- **Mailing address fax:** (208) 664-5345

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | M-7963 | ID | Yes |

## Other

- **Enumeration date:** 01/06/2010
- **Last updated:** 03/20/2013