Provider Demographics
NPI:1447305610
Name:DIRNE HEALTH CENTERS, INC
Entity type:Organization
Organization Name:DIRNE HEALTH CENTERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-620-5200
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:208-620-5200
Mailing Address - Fax:
Practice Address - Street 1:1090 WEST PARK PLACE
Practice Address - Street 2:SUITE B
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-292-0303
Practice Address - Fax:208-664-5346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIRNE HEALTH CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-25
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDDD0229OtherRAILROAD MEDICARE
IDDD0229OtherRAILROAD MEDICARE
ID131823Medicare Oscar/Certification