Organization Name: | KOOTENAI OUTPATIENT SURGERY CNTR LLC |
NPI Number: | 1740289024 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | VICKI ANN MOFFAT (DIRECTOR) |
Mailing Address: | 707 W Ironwood Dr Coeur D Alene |
State: | ID US |
Postal Code: | 838142772 |
Phone Number: | 2086662700 |
Fax Number: | 2086662713 |
NPI Enumeration Date: | 07/19/2005 |
NPI Last Update Date: | 01/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 307824 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ID |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |