Organization
NORTH IDAHO MEDICAL CARE CENTERS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS J LEGEL (CFO)
(208) 666-2000
Entity
Organization
Contact information
Practice address
1701 LINCOLN WAY, COEUR D ALENE, ID 83814-2537
(208) 667-9110
Mailing address
927 E POLSTON AVE, STE 303, POST FALLS, ID 83854-9811
(208) 664-3313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002606200
—
ID
01
—
1112918
MEDICARE
ID
Enumeration date
09/27/2006
Last updated
09/15/2010
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