Healthcare Provider Details

I. General information

NPI: 1932464989
Provider Name (Legal Business Name): NORTH IDAHO LUNG, ASTHMA AND CRITICAL CARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR SUITE 336
COEUR D ALENE ID
83814-2656
US

IV. Provider business mailing address

700 W IRONWOOD DR SUITE 336
COEUR D ALENE ID
83814-2656
US

V. Phone/Fax

Practice location:
  • Phone: 208-765-1252
  • Fax: 208-765-1494
Mailing address:
  • Phone: 208-765-1252
  • Fax: 208-765-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE E COX
Title or Position: OFFICE MANAGER
Credential:
Phone: 208-765-1252