Healthcare Provider Details

I. General information

NPI: 1205856481
Provider Name (Legal Business Name): CSA OF POST FALLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 N SYRINGA ST SUITE 102
POST FALLS ID
83854-5275
US

IV. Provider business mailing address

750 N SYRINGA AVE SUITE 102
POST FALLS ID
83854
US

V. Phone/Fax

Practice location:
  • Phone: 208-777-9877
  • Fax: 208-777-9833
Mailing address:
  • Phone: 208-777-9877
  • Fax: 208-777-9833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN COMBS
Title or Position: DIRECTOR
Credential: BS, RT (R)(CV)
Phone: 509-232-0567