| Lewis Clark Gastroenterology Pllc | |
|
1630 23rd Ave Suite 701 Lewiston ID 83501-6350 | |
| (208) 298-3002 | |
| (208) 298-7433 |
| Full Name | Lewis Clark Gastroenterology Pllc |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 1630 23rd Ave, Lewiston, Idaho |
| Authorized Official Name and Position | Tamara Lynn Smith (CLINICAL DIRECTOR) |
| Authorized Official Contact | 2082983002 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lewis Clark Gastroenterology Pllc 1630 23rd Ave Suite 701 Lewiston ID 83501-6350 Ph: (208) 298-3002 | Lewis Clark Gastroenterology Pllc 1630 23rd Ave Suite 701 Lewiston ID 83501-6350 Ph: (208) 298-3002 |
| NPI Number | 1356330922 |
|---|---|
| Provider Enumeration Date | 10/17/2005 |
| Last Update Date | 10/12/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356330922 | NPI | - | NPPES |
| 806979100 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
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