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General NPI Number Information
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NPI Number | 1093796468
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Entity Type | Organization
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Legal Business Name | COEUR D' ALENE ANESTHESIA
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1593 E POLSTON AVE
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City | POST FALLS
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State | ID
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Zip | 83854-5326
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Country | US
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Telephone | 208-262-2314
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Fax | 208-262-2394
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Provider Business Mailing Address
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Address Line | 1593 E POLSTON AVE
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City | POST FALLS
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State | ID
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Zip | 83854-5326
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Country | US
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Telephone | 208-262-2314
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Fax | 208-262-2394
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD ROCK
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Credential | CRNA
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Telephone | 208-262-2314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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