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NPI Code Detail

MEDICARE: CLEARWATER VALLEY HOSPITAL & CLINIC INC

MEDICARE: CLEARWATER VALLEY HOSPITAL & CLINIC 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 : 1891733747
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLEARWATER VALLEY HOSPITAL & CLINIC INC
Provider Business Mailing Address
First Line : 201 THENON ST
Second Line :
City : KOOSKIA
State : ID
Zip : 83539
Country : US
Telephone Number : 208-926-7801
Fax Number : 208-926-4721
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 : COO
Name : LARRY BARKER
Credential :
Telephone Number : 208-476-4555
Provider Enumeration Date : 06/03/2006
Last Update Date : 04/22/2008

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

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