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General NPI Number Information
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NPI Number | 1497997720
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Entity Type | Organization
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Legal Business Name | BOURGET HEALTH SERVICES
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 700 W IRONWOOD DR STE 108
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2656
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Country | US
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Telephone | 208-664-8249
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2687
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City | SPOKANE
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State | WA
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Zip | 99220-2687
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Country | US
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Telephone | 509-755-8600
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | KURT ROGERS
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Credential |
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Telephone | 509-755-8903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | MTS-0416
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License Number State | WA
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