| Coeur Vitality Pllc | |
|
110 E Wallace Ave Coeur D Alene ID 83814-2948 | |
| (208) 651-9791 | |
| Not Available |
| Full Name | Coeur Vitality Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 110 E Wallace Ave, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Brittany Burns (OWNER) |
| Authorized Official Contact | 2089664512 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coeur Vitality Pllc 110 E Wallace Ave Coeur D Alene ID 83814-2948 Ph: (208) 651-9791 | Coeur Vitality Pllc 110 E Wallace Ave Coeur D Alene ID 83814-2948 Ph: (208) 651-9791 |
| NPI Number | 1316574700 |
|---|---|
| Provider Enumeration Date | 03/25/2020 |
| Last Update Date | 08/17/2020 |
| Medicare PECOS PAC ID | 2365860343 |
|---|---|
| Medicare Enrollment ID | O20200909000527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316574700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Brittany C Burns |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730395310 PECOS PAC ID: 4880752773 Enrollment ID: I20081021000864 |
| Provider Name | George Christopher Bell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275608051 PECOS PAC ID: 7517966047 Enrollment ID: I20180417002176 |
| Provider Name | Brent Earl Hirschi |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1588990055 PECOS PAC ID: 4284774415 Enrollment ID: I20190402000569 |
| Provider Name | Kelli A Grambeau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306468483 PECOS PAC ID: 6608299409 Enrollment ID: I20200713002332 |
| Provider Name | Sharon L Anderson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1871810507 PECOS PAC ID: 9638596828 Enrollment ID: I20200902002375 |
| Provider Name | Jessica A Harnisch-boyd |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407319841 PECOS PAC ID: 9335522952 Enrollment ID: I20220815003038 |
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