Healthcare Provider Details

I. General information

NPI: 1104305648
Provider Name (Legal Business Name): HOSPITALIST MEDICINE PHYSICIANS OF IDAHO-TCG, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH ST
LEWISTON ID
83501-2431
US

IV. Provider business mailing address

1222 DEMONBREUN ST STE 1601
NASHVILLE TN
37203-7092
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-2511
  • Fax:
Mailing address:
  • Phone: 253-682-6040
  • Fax: 888-241-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA FALL
Title or Position: MANAGER
Credential:
Phone: 253-682-6040