Provider Type Icon

KOOTENAI TRIBE OF IDAHO NPI 1669594057


NPI Information

NPI: 1669594057
Provider Name: KOOTENAI TRIBE OF IDAHO

Other Name: KOOTENAI TRIBAL HEALTH CLINIC

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 13D0885727

Address:
100 CIRCLE DRIVE
BONNERS FERRY, ID
ZIP 83805
Phone: (208) 267-5223
Get Directions

KOOTENAI TRIBE OF IDAHO is a clinic center in Bonners Ferry, ID. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). KOOTENAI TRIBE OF IDAHO NPI is 1669594057. The provider is registered as an organization entity type.
The provider Other Name Is Kootenai Tribal Health Clinic.

The provider's business location address is:

100 CIRCLE DRIVE
BONNERS FERRY, ID
ZIP 83805-279
Phone: (208) 267-5223
Fax: (208) 267-8419

The provider's authorized official is Karen K Hanson .
The authorized official title is Health Clinic Director and has the following contact phone number (208) 267-5223.

The CLIA number assigned to this NPI record is 13D0885727 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 4/4/2007 and was last updated on 10/21/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/CenterYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11122316MEDICARE ID-TYPE UNSPECIFIEDIDAHO
2DC786OTHERIDAHOHMO
3E07077MEDICARE UPINIDAHO
4DC786OTHERIDAHOBLUE CROSS
5G007100MEDICAIDIDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.