Healthcare Provider Details

I. General information

NPI: 1992864342
Provider Name (Legal Business Name): JASON R SCHWINTEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 N MERRITT CREEK LOOP STE A
COEUR D ALENE ID
83814-4961
US

IV. Provider business mailing address

PO BOX 3687
COEUR D ALENE ID
83816-2529
US

V. Phone/Fax

Practice location:
  • Phone: 208-819-2183
  • Fax: 82-096-0632
Mailing address:
  • Phone: 208-819-2183
  • Fax: 208-209-6063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberM13065
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM-13065
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: