| Gritman Medical Center Inc | |
|
412 S Main St Troy ID 83871 | |
| (208) 835-5550 | |
| (208) 835-5554 |
| Full Name | Gritman Medical Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 412 S Main St, Troy, Idaho |
| Authorized Official Name and Position | Danielle Lynas (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 Medical Center Inc Po Box 8007 Moscow ID 83843-0507 Ph: (208) 883-2224 | Gritman Medical Center Inc 412 S Main St Troy ID 83871 Ph: (208) 835-5550 |
| NPI Number | 1477004828 |
|---|---|
| Provider Enumeration Date | 10/20/2016 |
| Last Update Date | 07/06/2022 |
| Medicare PECOS PAC ID | 4981984390 |
|---|---|
| Medicare Enrollment ID | O20161130002249 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477004828 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Bryan J Anderson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1811059264 PECOS PAC ID: 1658393491 Enrollment ID: I20051221000486 |
| Provider Name | Gregory P Bauer |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1255496493 PECOS PAC ID: 6901719301 Enrollment ID: I20070831000060 |
| Provider Name | Marvin R Kym |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1316932601 PECOS PAC ID: 8123929072 Enrollment ID: I20100915000242 |
| Provider Name | John Barclay Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912008095 PECOS PAC ID: 7911194915 Enrollment ID: I20101202001092 |
| Provider Name | Fawna S Huffman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356680862 PECOS PAC ID: 6305091653 Enrollment ID: I20130313000019 |
| Provider Name | Olisa M Bomley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447691621 PECOS PAC ID: 0941438923 Enrollment ID: I20140121000977 |
| Provider Name | Bryan D Smith |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1548243199 PECOS PAC ID: 3274608542 Enrollment ID: I20140818002510 |
| Provider Name | Lee J Hixson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1952314593 PECOS PAC ID: 7517956337 Enrollment ID: I20160324001906 |
| Provider Name | Dustin P Gill |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1558681502 PECOS PAC ID: 4587796222 Enrollment ID: I20190725003692 |
| Provider Name | Jacob Kent Christensen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407237043 PECOS PAC ID: 4587973268 Enrollment ID: I20191018000276 |
| Provider Name | Jennifer L Rouse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710565551 PECOS PAC ID: 7113335415 Enrollment ID: I20210427001540 |
| Provider Name | Brian Edward Newell |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1932562980 PECOS PAC ID: 2860745908 Enrollment ID: I20210901002059 |
| Provider Name | Christopher Bullard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306379052 PECOS PAC ID: 4385912294 Enrollment ID: I20210921001203 |
| Provider Name | Brandy N Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427591270 PECOS PAC ID: 7911274477 Enrollment ID: I20220121002407 |
| Provider Name | Mark Mitchell Roubidoux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629685235 PECOS PAC ID: 9638577828 Enrollment ID: I20220209002036 |
| Provider Name | Kim Marie Schorer |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1023242302 PECOS PAC ID: 7416094842 Enrollment ID: I20220628002958 |
| Provider Name | Preetha Rosen |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1487886099 PECOS PAC ID: 9638340813 Enrollment ID: I20220907000424 |
| Provider Name | Adam James Kappmeyer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326603531 PECOS PAC ID: 3870823974 Enrollment ID: I20230808001555 |
| Provider Name | Steven Willis Beckstrom |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1316033210 PECOS PAC ID: 1557378411 Enrollment ID: I20240919003076 |
| Provider Name | Ashley L George |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1023629334 PECOS PAC ID: 8123445715 Enrollment ID: I20240925003421 |
| Provider Name | Daniel Kenneth Tucker |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1760543078 PECOS PAC ID: 4587672621 Enrollment ID: I20241022001979 |