Basic Information
Provider Information
NPI: 1215964952
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOSS
FirstName: SCOTT
MiddleName: D
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2003 KOOTENAI HEALTH WAY
Address2:  
City: COEUR D ALENE
State: ID
PostalCode: 838146051
CountryCode: US
TelephoneNumber: 2086255085
FaxNumber: 2086255731
Practice Location
Address1: 2003 KOOTENAI HEALTH WAY
Address2:  
City: COEUR D ALENE
State: ID
PostalCode: 838146051
CountryCode: US
TelephoneNumber: 2086256900
FaxNumber: 2086256910
Other Information
ProviderEnumerationDate: 06/27/2006
LastUpdateDate: 01/18/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XM-12264IDN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000XM12264IDY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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