Healthcare Provider Details

I. General information

NPI: 1619344637
Provider Name (Legal Business Name): TMHCARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 NORTHWEST BLVD STE 200
COEUR D ALENE ID
83814-2973
US

IV. Provider business mailing address

250 NORTHWEST BLVD STE 200
COEUR D ALENE ID
83814-2973
US

V. Phone/Fax

Practice location:
  • Phone: 208-215-1568
  • Fax:
Mailing address:
  • Phone: 208-215-1568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101258812
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAXINE MCELREE
Title or Position: CFO
Credential:
Phone: 208-446-5127