=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558477471
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES V. KIRBY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 04/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2005 N IRONWOOD PKWY STE 138
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-2647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-202-2424
-----------------------------------------------------
Fax | 208-953-7896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2003 KOOTENAI HEALTH WAY
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-6051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-625-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | M10766
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------