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General NPI Number Information
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NPI Number | 1740289024
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Entity Type | Organization
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Legal Business Name | KOOTENAI OUTPATIENT SURGERY CNTR LLC
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 707 W IRONWOOD DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2772
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Country | US
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Telephone | 208-625-6400
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Fax | 208-625-6401
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Provider Business Mailing Address
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Address Line | 707 W IRONWOOD DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2772
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Country | US
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Telephone | 208-625-6400
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Fax | 208-625-6401
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHIRLEY M TORWIRT
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Credential | CASC
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Telephone | 208-625-6428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 307824
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 307824
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License Number State | ID
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