Provider Demographics
NPI:1205030293
Name:KOOTENAI HEALTH, INC.
Entity Type:Organization
Organization Name:KOOTENAI HEALTH, INC.
Other - Org Name:KOOTENAI MEDICAL CENTER KPC MID LEVEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:NESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-625-5081
Mailing Address - Street 1:2003 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2611
Mailing Address - Country:US
Mailing Address - Phone:208-666-2668
Mailing Address - Fax:208-666-3088
Practice Address - Street 1:2003 KOOTENAI HEALTH WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-6051
Practice Address - Country:US
Practice Address - Phone:208-666-2668
Practice Address - Fax:208-666-3088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID42282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807728100Medicaid