PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC (NPI# 1205104593) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205104593 |
| Entity Type | Organization |
| Organization Name | PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC |
| Other Organization Name | PALOUSE PEDIATRICS - MOSCOW |
| Practice Address |
1420 S Blaine St Ste 5 Moscow ID 83843-3973 |
| Mailing Address |
840 Se Bishop Blvd Ste 101 Pullman WA 99163-5502 |
| Practice Telephone | 2088822247 |
| Practice Fax Number | 5093367482 |
| Mailing Telephone | 5093326139 |
| Mailing Fax Number | 5093326579 |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2015-06-26 |
| Authorized Official Name | GROVER 'PETE' C PETERS III (CLINIC ADMINISTRATOR) |
| Authorized Official Telephone | 5093326139 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
13-3860 | ID | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | MEDICARE PTAN | 1369068 | 01 |
| ID | CMS CERTIFICATION | 13-3860 | 01 |
| Other Name | Type Code |
|---|---|
| Palouse Pediatrics - Moscow | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063646107 | Pullman Regional Hospital Clinic Network LLC | Family Medicine | 1205 Se Pro Mall Blvd Ste 104, Pullman, WA 99163-5423 | 2009-05-04 |
| Street Address |
1420 S BLAINE ST STE 5 |
| City | MOSCOW |
| State | ID |
| Zip Code | 83843-3973 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033726880 | Moscow Physical Therapy, LLC | Clinic/Center | 1174 Alturas Drive, Suite 2, Moscow, ID 83843 | 2020-09-25 |
| 1831703057 | Hydee Flishaw Tubbs Becker | Dietitian, Registered | 614 North Hayes Street, Moscow, ID 83843 | 2020-09-04 |
| 1528626959 | Ryan Steven Clark | Student in an Organized Health Care Education/Training Program | 212 Farm Road, #201, Moscow, ID 83843 | 2019-05-31 |
| 1770141384 | Lingwen Zhang | Specialist/Technologist | 901 Paradise Creek Rd, Moscow, ID 83843 | 2019-05-30 |
| 1306363478 | Elizabeth Campbell | Dietitian, Registered | 611 S. Main, Moscow, ID 83843 | 2017-08-29 |
| 1598285496 | Gina Cretser | Counselor | 212 Rodeo Dr. #410, Moscow, ID 83843 | 2017-06-21 |
| 1124558721 | Morgan Leigh Derloshon | Specialist/Technologist | 275 Southview Ave, Apt 206, Moscow, ID 83843 | 2017-06-15 |
| 1619411790 | Kaylene Howard | Massage Therapist | 127 South Washington, Suite 6, Moscow, ID 83843 | 2016-12-08 |
| 1407237043 | Jacob Kent Christensen | Family Medicine | 831 S Ash St, Moscow, ID 83843 | 2015-06-09 |
| 1366851388 | Elisabeth Henry | Pharmacist | 2740 West Pullman Rd, Moscow, ID 83843 | 2014-08-04 |
| Find all providers in zip 83843 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376160457 | North Canyon Jerome Clinic | Clinic/Center | 491 Heritage Dr, Jerome, ID 83338-6701 | 2020-07-06 |
| 1063970143 | Idaho Street Medical Clinic | Clinic/Center | 126 Idaho Ave., Homedale, ID 83628-8362 | 2019-03-07 |
| 1568950566 | North Canyon Medical Center, Inc. | Clinic/Center | 718 Hwy 30, Buhl, ID 83316 | 2018-04-25 |
| 1518377019 | North Canyon Medical Center, Inc. | Clinic/Center | 267 N. Canyon Drive, Gooding, ID 83330 | 2014-05-06 |
| 1700206588 | Mvh Bmc LLC | Clinic/Center | 210 S Emerson Ave, Shelley, ID 83274-1229 | 2014-04-21 |
| 1922243088 | Bmh Inc | Clinic/Center | 1355 Parkway Dr, Blackfoot, ID 83221-1656 | 2008-12-03 |
| 1023271731 | Upper Valley Family Medicine Rhc | Clinic/Center | 530 Rigby Lake Dr, Rigby, ID 83442-1271 | 2008-07-03 |
| 1891984167 | Bmh Inc | Clinic/Center | 1425 Parkway Drive, Blackfoot, ID 83221-1758 | 2007-10-23 |
| 1043387426 | Minidoka Memorial Hospital | Clinic/Center | 1308 8th St, Suite 1, Rupert, ID 83350-1530 | 2006-11-29 |
| 1356438816 | Gritman Medical Center Inc | Clinic/Center | 156 6th St, Potlatch, ID 83855 | 2006-10-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.