Healthcare Provider Details

I. General information

NPI: 1215936638
Provider Name (Legal Business Name): NORTH IDAHO DERMATOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2199 N MERRITT CREEK LOOP
COEUR D ALENE ID
83814-4949
US

IV. Provider business mailing address

2199 N MERRITT CREEK LOOP
COEUR D ALENE ID
83814-4949
US

V. Phone/Fax

Practice location:
  • Phone: 208-665-7546
  • Fax: 208-667-4607
Mailing address:
  • Phone: 208-665-7546
  • Fax: 208-667-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN C RINGGER
Title or Position: OWNER
Credential: MD
Phone: 208-665-7546