1760816037 NPI number — NORTH IDAHO REHABILITATION MEDICINE, PLLC

Table of content: (NPI 1760816037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760816037 NPI number — NORTH IDAHO REHABILITATION MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH IDAHO REHABILITATION MEDICINE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760816037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2407 W RAINIER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99208-9259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-293-2276
Provider Business Mailing Address Fax Number:
818-889-0517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 N CECIL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-293-2276
Provider Business Practice Location Address Fax Number:
818-889-0517
Provider Enumeration Date:
08/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GROSSE
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-293-2276

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  M-11628 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com