=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609909282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM F. GANZ MD FACS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 05/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2236 N MERRIT CREEK LOOP SUITE A
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-4960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-664-5467
-----------------------------------------------------
Fax | 208-765-4696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2236 N MERRIT CREEK LOOP SUITE A
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-4960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-664-5467
-----------------------------------------------------
Fax | 208-765-4696
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. LUANN GANZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-664-5467
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | M8313
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------