Provider Type Icon

PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC NPI 1205104593


NPI Information

NPI: 1205104593
Provider Name: PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC

Doing Business As: PALOUSE PEDIATRICS - MOSCOW

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

CLIA Number: 50D0638906

Address:
1420 S BLAINE ST STE 5
MOSCOW, ID
ZIP 83843
Phone: (208) 882-2247
Get Directions

PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC is a rural health clinic center in Moscow, ID. PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC NPI is 1205104593. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Palouse Pediatrics - Moscow.

The provider's business location address is:

1420 S BLAINE ST STE 5
MOSCOW, ID
ZIP 83843-973
Phone: (208) 882-2247
Fax: (509) 336-7482

The provider's authorized official is Grover 'pete' C Peters .
The authorized official title is Clinic Administrator and has the following contact phone number (509) 332-6139.

The CLIA number assigned to this NPI record is 50D0638906 - hospital with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 12/1/2011 and was last updated on 6/26/2015.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsNo
22084P0800XPsychiatry & NeurologyPsychiatryNo
3261QR1300XClinic/CenterRural Health13-3860IDAHOYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11369068OTHERIDAHOMEDICARE PTAN
213-3860OTHERIDAHOCMS CERTIFICATION

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: 11/14/2023

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.