# KOOTENAI URGENT CARE LLC

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

## Provider details

- **NPI number:** 1407172059
- **Authorized official:** ERIC KOELSCH (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (208) 676-0145

## Contact information

- **Practice address:** 566 W PRAIRIE AVE, COEUR D ALENE, ID 83815-7766
- **Practice address phone:** (208) 772-9110
- **Practice address fax:** (208) 772-0590
- **Mailing address:** 700 W IRONWOOD DR, SUITE 272E, COEUR D ALENE, ID 83814-2656
- **Mailing address phone:** (208) 676-0102
- **Mailing address fax:** (208) 676-0147

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/07/2010
- **Last updated:** 03/22/2012