Healthcare Provider Details

I. General information

NPI: 1104658152
Provider Name (Legal Business Name): NORTH IDAHO ENDOSCOPY AND SURGICAL SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3318 N GRANDMILL LN
COEUR D ALENE ID
83814-5689
US

IV. Provider business mailing address

784 S CLEARWATER LOOP # 4128
POST FALLS ID
83854-9599
US

V. Phone/Fax

Practice location:
  • Phone: 208-292-0445
  • Fax: 208-772-6514
Mailing address:
  • Phone: 775-240-1338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CORY RICHARDSON
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 775-240-1338