Healthcare Provider Details

I. General information

NPI: 1407499445
Provider Name (Legal Business Name): PALOUSE SPECIALTY PHYSICIANS, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 S MAIN ST STE 110
MOSCOW ID
83843-2695
US

IV. Provider business mailing address

PO BOX 847
PULLMAN WA
99163-0847
US

V. Phone/Fax

Practice location:
  • Phone: 208-813-7519
  • Fax: 208-813-7524
Mailing address:
  • Phone: 509-330-5607
  • Fax: 509-334-6477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SACHA L SMITH
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 208-882-1700