Provider Demographics
NPI:1437973674
Name:BEACON CANCER CARE PLLC
Entity type:Organization
Organization Name:BEACON CANCER CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CADWELL
Authorized Official - Last Name:BARTELS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-755-2804
Mailing Address - Street 1:3815 N SCHREIBER WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8434
Mailing Address - Country:US
Mailing Address - Phone:208-755-2804
Mailing Address - Fax:208-765-0277
Practice Address - Street 1:3815 N SCHREIBER WAY UNIT 101
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8434
Practice Address - Country:US
Practice Address - Phone:208-755-2804
Practice Address - Fax:208-765-0277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEACON CANCER CARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy