National Provider Identifier Database

PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC
Rural Health


Contact Information

PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC
1420 S BLAINE ST STE 5
MOSCOW, ID83843-3973
Phone: 208-882-2247
Fax: 509-336-7482
Website:
Specialty Taxonomy Code
* Rural Health 261QR1300X
Pediatrics 208000000X
Psychiatry 2084P0800X

* Indicates primary specialty

NPI Profile & details for PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC

NPI Number 1205104593
Legal business name
LBN
PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC
Authorized official GROVER 'PETE' PETERS - (CLINIC ADMINISTRATOR)
Entity Organization
Organization subpart No
Enumeration date 12/01/2011
Last updated 06/26/2015 - About 11 years ago
Sole proprietor1 Not specified
Identifiers
  • ID License #: 13-3860
  • ID Other: 13-3860 CMS CERTIFICATION
  • ID Other: 1369068 MEDICARE PTAN

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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