| Moscow Medical, P.a. | |
|
213 N Main St Moscow ID 83843-2700 | |
| (208) 882-7565 | |
| Not Available |
| Full Name | Moscow Medical, P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 213 N Main St, Moscow, Idaho |
| Authorized Official Name and Position | Kathy Cornish (BILLING MANAGER) |
| Authorized Official Contact | 2087463653 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moscow Medical, P.a. 213 N Main St Moscow ID 83843-2700 Ph: (208) 882-7565 | Moscow Medical, P.a. 213 N Main St Moscow ID 83843-2700 Ph: (208) 882-7565 |
| NPI Number | 1871646976 |
|---|---|
| Provider Enumeration Date | 01/19/2007 |
| Last Update Date | 03/31/2009 |
| Medicare PECOS PAC ID | 8325006463 |
|---|---|
| Medicare Enrollment ID | O20071010000836 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871646976 | NPI | - | NPPES |
| 133858 | Other | ID | MEDICARE RHC |
| 002262200 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Idaho) | Primary |
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