Healthcare Provider Details

I. General information

NPI: 1750204129
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRICT #1-A OF WHITMAN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S BLAINE ST STE 5
MOSCOW ID
83843-3973
US

IV. Provider business mailing address

1420 S BLAINE ST STE 5
MOSCOW ID
83843-3973
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-2247
  • Fax:
Mailing address:
  • Phone: 208-882-2247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATT FORGE CEO
Title or Position: CEO
Credential:
Phone: 509-336-7300