Organization
ASC NORTHWEST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLIE CARTER (PRACTICE MANAGER)
(208) 667-1376
Entity
Organization
Contact information
Practice address
850 W IRONWOOD DR STE B-101, COEUR D ALENE, ID 83814-4903
(208) 667-1376
Mailing address
850 W IRONWOOD DR STE B-101, COEUR D ALENE, ID 83814-4903
(208) 667-1376
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
11/17/2020
Last updated
04/12/2021
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