Organization
KOOTENAI TRIBE OF IDAHO
Active
Other names
Kootenai Tribal Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN K HANSON (HEALTH CLINIC DIRECTOR)
(208) 267-5223
Entity
Organization
Contact information
Practice address
100 CIRCLE DRIVE, BONNERS FERRY, ID 83805-1279
(208) 267-5223
(208) 267-8419
Mailing address
PO BOX T, BONNERS FERRY, ID 83805-1279
(208) 267-5223
(208) 267-8419
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC786
BLUE CROSS
ID
05
—
G007100
—
ID
Enumeration date
04/04/2007
Last updated
10/21/2010
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