Kaniksu Community Health | |
30410 Highway 200 Ponderay ID 83852-9601 | |
(208) 263-7101 | |
Not Available |
Full Name | Kaniksu Community Health |
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Speciality | Clinic/Center |
Location | 30410 Highway 200, Ponderay, Idaho |
Authorized Official Name and Position | Kevin Knepper (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 2082633410 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Kaniksu Community Health Po Box 2160 Sandpoint ID 83864-0908 Ph: (208) 263-3410 | Kaniksu Community Health 30410 Highway 200 Ponderay ID 83852-9601 Ph: (208) 263-7101 |
NPI Number | 1811054877 |
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Provider Enumeration Date | 01/02/2007 |
Last Update Date | 12/03/2021 |
Medicare PECOS PAC ID | 2264341221 |
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Medicare Enrollment ID | O20050824001104 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811054877 | NPI | - | NPPES |
8065901 | Medicaid | ID | |
DB1056 | Other | RAILROAD MEDICARE |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |