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803 S. Main Street Ste 120 Moscow ID 83843 | |
(509) 444-8888 | |
(509) 444-7806 |
Full Name | |
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Speciality | Clinic/Center |
Location | 803 S. Main Street, Moscow, Idaho |
Authorized Official Name and Position | Aaron Wilson (CEO) |
Authorized Official Contact | 5094448888 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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611 N Iron Bridge Way Spokane WA 99202-4932 Ph: (509) 444-8888 | 803 S. Main Street Ste 120 Moscow ID 83843 Ph: (509) 444-8888 |
NPI Number | 1285077230 |
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Provider Enumeration Date | 04/09/2013 |
Last Update Date | 09/29/2021 |
Medicare PECOS PAC ID | 9638063217 |
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Medicare Enrollment ID | O20140307000218 |
Identifier | Type | State | Issuer |
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1285077230 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Community Healthcare Of The Palouse Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 619 S Washington St, Ste 203, Moscow, ID 83843 Phone: 208-892-1346 Fax: 208-892-8306 | |
Gritman Medical Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2400 W A St Ste G, Moscow, ID 83843 Phone: 208-882-4511 Fax: 208-883-6580 | |