Provider Demographics
NPI:1720033368
Name:FAMILY MEDICINE COEUR D'ALENE, P.A.
Entity Type:Organization
Organization Name:FAMILY MEDICINE COEUR D'ALENE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-667-2541
Mailing Address - Street 1:700 W IRONWOOD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2666
Mailing Address - Country:US
Mailing Address - Phone:208-667-2541
Mailing Address - Fax:208-664-1173
Practice Address - Street 1:700 W IRONWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2666
Practice Address - Country:US
Practice Address - Phone:208-667-2541
Practice Address - Fax:208-664-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1371095Medicare ID - Type Unspecified