| Gritman Internal Medicine Clinic | |
|
804 S Washington St Ste A Moscow ID 83843-3182 | |
| (208) 883-1152 | |
| (208) 882-1486 |
| Full Name | Gritman Internal Medicine Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 804 S Washington St Ste A, Moscow, Idaho |
| Authorized Official Name and Position | Patrick Mcconnell (INTERM CFO) |
| Authorized Official Contact | 2088832220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gritman Internal Medicine Clinic Po Box 8007 Moscow ID 83843-0507 Ph: (208) 883-1152 | Gritman Internal Medicine Clinic 804 S Washington St Ste A Moscow ID 83843-3182 Ph: (208) 883-1152 |
| NPI Number | 1235680703 |
|---|---|
| Provider Enumeration Date | 10/20/2016 |
| Last Update Date | 10/24/2016 |
| Medicare PECOS PAC ID | 4981984390 |
|---|---|
| Medicare Enrollment ID | O20201020001059 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235680703 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 39 (Idaho) | Primary |
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