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222 Southway Ave Ste C Lewiston ID 83501-2703 | |
| (208) 792-1011 | |
| (208) 616-1453 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 222 Southway Ave Ste C, Lewiston, Idaho |
| Authorized Official Name and Position | Jennifer Grinage (OWNER/CEO) |
| Authorized Official Contact | 2087921011 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 225 Lewiston ID 83501-0225 Ph: (208) 792-1011 | 222 Southway Ave Ste C Lewiston ID 83501-2703 Ph: (208) 792-1011 |
| NPI Number | 1144057852 |
|---|---|
| Provider Enumeration Date | 09/17/2024 |
| Last Update Date | 11/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144057852 | NPI | - | NPPES |
| 1396151395 | Other | PROVIDER NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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St Joseph Hospital Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 341 Saint Johns Way, Lewiston, ID 83501 Phone: 615-844-9800 Fax: 615-844-9883 |