Organization
COEUR D ALENE SPINE AND BRAIN PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA RAE TANSY (ADMINISTRATOR)
(208) 765-9100
Entity
Organization
Contact information
Practice address
3320 N GRAND MILL LN, COEUR D ALENE, ID 83814-5689
(208) 765-9100
(208) 765-9103
Mailing address
3320 N GRAND MILL LN, COEUR D ALENE, ID 83814-5689
(208) 765-9100
(208) 765-9103
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M8677
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010143406
REGENCE BLUESHIELD
—
01
—
0172116
WASHINGTON L & I
—
01
—
205112900
OWCP
—
05
—
7116981
—
WA
05
—
806619500
—
ID
01
—
8948154
CRIME VICTIMS COMP FUND
—
01
—
8H195
BLUE CROSS OF IDAHO
—
01
—
DA4210
MEDICARE RR
—
Enumeration date
01/11/2007
Last updated
02/23/2023
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