National Provider Identifier Database

CLEARWATER MEDICAL CENTER PLLC
Family


Contact Information

CLEARWATER MEDICAL CENTER PLLC
1522 17TH ST
LEWISTON, ID83501-3652
Phone: 208-743-8416
Fax: 208-743-4642
Website:
Specialty Taxonomy Code
* Family 363LF0000X
Family Medicine 207Q00000X

* Indicates primary specialty

NPI Profile & details for CLEARWATER MEDICAL CENTER PLLC

NPI Number 1558452268
Legal business name
LBN
CLEARWATER MEDICAL CENTER PLLC
Authorized official CELSO CHAVEZ - (OWNER PHYSICIAN)
Entity Organization
Organization subpart No
Enumeration date 09/27/2006
Last updated 12/16/2008 - About 17 years ago
Sole proprietor1 Not specified
Identifiers
  • License #: NP361A
  • ID License #: A87025
  • ID License #: NP372A
  • ID License #: NP388A
  • ID License #: NP390A
  • ID License #: NP740A
  • ID License #: NP751A

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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