National Provider Identifier Database

COEUR DALENE SURGICAL AND VEIN
Medical Specialty

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).


Contact Information

COEUR D'ALENE SURGICAL AND VEIN
608 NORTHWEST BLVD
SUITE 301
COEUR D'ALENE, ID83814-2174
Phone: 208-664-4940
Fax: 208-664-5345
Website:
Specialty Taxonomy Code
* Medical Specialty 261QM2500X

* Indicates primary specialty

NPI Profile & details for COEUR D'ALENE SURGICAL AND VEIN

NPI Number 1225368632
Legal business name
LBN
COEUR D'ALENE SURGICAL AND VEIN
Authorized official KEVIN JOHNSON - (MANAGING MEMBER)
Entity Organization
Organization subpart No
Enumeration date 01/06/2010
Last updated 03/20/2013 - About 13 years ago
Sole proprietor1 Not specified
Identifiers
  • ID License #: M-7963

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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