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NPI Code Detail

MEDICARE: CLEARWATER VALLEY HOSPITAL & CLINICS INC

MEDICARE: CLEARWATER VALLEY HOSPITAL & CLINICS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073551396
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLEARWATER VALLEY HOSPITAL & CLINICS INC
Provider Business Mailing Address
First Line : 301 CEDAR ST
Second Line :
City : OROFINO
State : ID
Zip : 83544-9029
Country : US
Telephone Number : 208-476-4555
Fax Number : 208-476-5385
Provider Business Practice Location Address
First Line : 301 CEDAR ST
Second Line :
City : OROFINO
State : ID
Zip : 83544-9029
Country : US
Telephone Number : 208-476-4555
Fax Number : 208-476-5385
Authorized Official
Title or Position : CFO
Name : LENNE J BONNER
Credential :
Telephone Number : 208-476-4555
Provider Enumeration Date : 06/02/2006
Last Update Date : 05/08/2014

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Directions to “CLEARWATER VALLEY HOSPITAL & CLINICS INC ” Practice Location

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