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General NPI Number Information
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NPI Number | 1437973674
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Entity Type | Organization
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Legal Business Name | BEACON CANCER CARE PLLC
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 3815 N SCHREIBER WAY UNIT 101
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City | COEUR D ALENE
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State | ID
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Zip | 83815-8434
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Country | US
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Telephone | 208-755-2804
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Fax | 208-765-0277
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Provider Business Mailing Address
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Address Line | 3815 N SCHREIBER WAY UNIT 101
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City | COEUR D ALENE
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State | ID
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Zip | 83815-8434
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Country | US
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Telephone | 208-755-2804
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Fax | 208-765-0277
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DAVID CADWELL BARTELS
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Credential | DO
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Telephone | 208-755-2804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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