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Contact Information

DOUGLAS W RUSNACK, MD
601 FRONT AVENUE
SUITE #502
COEUR D'ALENE, ID83814
 Phone: 208-415-0524
 Fax: 208-763-3644
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Diagnostic Radiology

2085R0202X 30 Physician/Diagnostic Radiology
Indicates primary specialty

NPI Profile & details for DOUGLAS W RUSNACK · (Male)

NPI Number 1336101005
Status Active
Credentials MD
Entity Individual
Enumeration date 04/06/2006
Last updated 05/27/2009 - About 17 years ago
Sole proprietor 1 Yes
Identifiers
  • ID License # M9059
  • KY Medicaid 7100025000
  • OH Medicaid 2799048
  • PA Medicaid 1019685500001
  • VA Medicaid 010394856
  • KY Other 000000548198 ANTHEM
  • KY Other 50017549 PASSPORT
  • KY Other 3425603000 PASSPORT ADVANTAGE
  • KY Other 91732 SIHO
  • PA Other 2501251 MEDICAL ASSISTANCE NY
  • PA Other 2799048 MEDICAL ASSISTANCE OH
  • PA Other 1019685500001 MEDICAL ASSISTANCE PA
Hospital affiliation(s)
  • ANTELOPE VALLEY HOSPITAL MED CENTER - (Acute Care)
    1600 W AVE J
    LANCASTER, CA 93534
  • GLENDALE MEMORIAL HOSPITAL & HEALTH CENTER - (Acute Care)
    1420 S CENTRAL AVE
    GLENDALE, CA 91204
  • NORTHRIDGE HOSPITAL MEDICAL CENTER - (Acute Care)
    18300 ROSCOE BLVD
    NORTHRIDGE, CA 91325
  • PROVIDENCE SAINT JOSEPH MEDICAL CTR - (Acute Care)
    501 SOUTH BUENA VISTA
    BURBANK, CA 91505
  • ST MARY MEDICAL CENTER - (Acute Care)
    1050 LINDEN AVE
    LONG BEACH, CA 90813
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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