| Potlatch Clinic | |
|
156 6th St Potlatch ID 83855 | |
| (208) 875-2380 | |
| (208) 875-2303 |
| Full Name | Potlatch Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 156 6th St, Potlatch, Idaho |
| Authorized Official Name and Position | Kara L Besst (CEO) |
| Authorized Official Contact | 2088832220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Potlatch Clinic 700 S Main St Moscow ID 83843 Ph: (208) 882-4511 | Potlatch Clinic 156 6th St Potlatch ID 83855 Ph: (208) 875-2380 |
| NPI Number | 1356438816 |
|---|---|
| Provider Enumeration Date | 10/06/2006 |
| Last Update Date | 02/14/2017 |
| Medicare PECOS PAC ID | 4981984390 |
|---|---|
| Medicare Enrollment ID | O20170127002176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356438816 | NPI | - | NPPES |
| 000010138303 | Other | ID | REGENCE |
| 7095847 | Medicaid | WA | |
| 805681000 | Medicaid | ID | |
| 8A612 | Other | ID | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 39 (Idaho) | Primary |