MEDICARE: IRONWOOD FAMILY PRACTICE, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		ID

General Provider Information

NPI Number	:	1083650931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRONWOOD FAMILY PRACTICE, PA

Provider Business Mailing Address
First Line	:	3815 N SCHREIBER WAY UNIT 102
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-8434
Country	:	US
Telephone Number	:	208-667-4557
Fax Number	:	208-765-2887

Provider Business Practice Location Address
First Line	:	3815 N SCHREIBER WAY UNIT 102
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-8434
Country	:	US
Telephone Number	:	208-667-4557
Fax Number	:	208-765-2887

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	NINA RUTH EVERSON
Credential	:
Telephone Number	:	208-667-4557

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	01/10/2025

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Directions to “IRONWOOD FAMILY PRACTICE, PA ” Practice Location

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