| Total Health Physician Group Llc | |
|
619 S Washington St Suite 203 Moscow ID 83843-3090 | |
| (208) 892-1346 | |
| (208) 892-8306 |
| Full Name | Total Health Physician Group Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 619 S Washington St, Moscow, Idaho |
| Authorized Official Name and Position | Robert N Spady (PRESIDENT) |
| Authorized Official Contact | 2088921346 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Total Health Physician Group Llc 619 S Washington St Ste 203 Moscow ID 83843-3063 Ph: (208) 892-1346 | Total Health Physician Group Llc 619 S Washington St Suite 203 Moscow ID 83843-3090 Ph: (208) 892-1346 |
| NPI Number | 1043492655 |
|---|---|
| Provider Enumeration Date | 12/05/2007 |
| Last Update Date | 03/11/2021 |
| Medicare PECOS PAC ID | 0648356543 |
|---|---|
| Medicare Enrollment ID | O20080318000369 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043492655 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Robert Spady |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053329490 PECOS PAC ID: 7517957137 Enrollment ID: I20080318000591 |
| Provider Name | Laurie Susanne Edinger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720194954 PECOS PAC ID: 6709236995 Enrollment ID: I20250221000814 |
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