Provider Demographics
NPI:1609909282
Name:WILLIAM F. GANZ MD FACS PLLC
Entity Type:Organization
Organization Name:WILLIAM F. GANZ MD FACS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GANZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-664-5467
Mailing Address - Street 1:2236 N MERRIT CREEK LOOP
Mailing Address - Street 2:SUITE A
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4960
Mailing Address - Country:US
Mailing Address - Phone:208-664-5467
Mailing Address - Fax:208-765-4696
Practice Address - Street 1:2236 N MERRIT CREEK LOOP
Practice Address - Street 2:SUITE A
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4960
Practice Address - Country:US
Practice Address - Phone:208-664-5467
Practice Address - Fax:208-765-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8313207T00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC5047OtherRR MEDICARE
ID8060855Medicaid
ID8073659Medicaid
6301650001Medicare NSC
ID8060855Medicaid