Healthcare Provider Details

I. General information

NPI: 1619988144
Provider Name (Legal Business Name): GRITMAN MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S MAIN ST
MOSCOW ID
83843-3056
US

IV. Provider business mailing address

PO BOX 8007
MOSCOW ID
83843-0507
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-4511
  • Fax: 208-883-6580
Mailing address:
  • Phone: 208-882-4511
  • Fax: 208-883-6580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number39
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. KARA L BESST
Title or Position: PRESIDENT/ CEO
Credential:
Phone: 208-882-4511