| Trace Heavener, DO | |
|
1919 Lincoln Way Ste 415, Coeur D Alene, ID 83814-2527 | |
| (208) 625-4595 | |
| (208) 625-4596 |
| Full Name | Trace Heavener |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine - Gastroenterology |
| Location | 1919 Lincoln Way Ste 415, Coeur D Alene, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841646726 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | O-1809 (Idaho) | Primary |
| Entity Name | Concord Medical Group Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083630610 PECOS PAC ID: 0446296818 Enrollment ID: O20050707000531 |
| Entity Name | Concord Medical Group Of Texas Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1750790762 PECOS PAC ID: 7810117223 Enrollment ID: O20141007002567 |
| Mailing Address | Practice Location Address |
|---|---|
| Trace Heavener, DO 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 Ph: (208) 625-4595 | Trace Heavener, DO 1919 Lincoln Way Ste 415, Coeur D Alene, ID 83814-2527 Ph: (208) 625-4595 |
Diana Johns, Gastroenterology Medicare: Not Enrolled in Medicare Practice Location: 2248 W Rosebud Ln, Coeur D Alene, ID 83814 Phone: 907-687-6248 | |
Marc Olav Granrud, Gastroenterology Medicare: Accepting Medicare Assignments Practice Location: 2003 Kootenai Health Way, Coeur D Alene, ID 83814 Phone: 208-625-6900 Fax: 208-625-6710 | |
Kevin Nathaniel Brown, MD Gastroenterology Medicare: Medicare Enrolled Practice Location: 2003 Kootenai Health Way, Coeur D Alene, ID 83814 Phone: 208-625-6900 Fax: 208-625-6910 | |
Edward J Macinerney, M.D. Gastroenterology Medicare: Accepting Medicare Assignments Practice Location: 700 W Ironwood Dr Ste 320, Coeur D Alene, ID 83814 Phone: 208-625-5250 Fax: 208-625-5251 | |
Pablo Fernando Michel Sanchez, M.D. Gastroenterology Medicare: Medicare Enrolled Practice Location: 700 W Ironwood Dr Ste 350, Coeur D Alene, ID 83814 Phone: 208-625-5250 Fax: 208-625-5251 | |
Dr. Amanda Rose Liggett, M.D. Gastroenterology Medicare: Accepting Medicare Assignments Practice Location: 700 W Ironwood Dr Ste 378, Coeur D Alene, ID 83814 Phone: 208-625-3555 Fax: 208-765-1494 | |
Dr. Robert Scoggins, M.D., PH.D. Gastroenterology Medicare: Accepting Medicare Assignments Practice Location: 700 W Ironwood Dr Ste 378, Coeur D Alene, ID 83814 Phone: 208-765-1252 Fax: 208-765-1494 |