Healthcare Provider Details

I. General information

NPI: 1548299696
Provider Name (Legal Business Name): PALOUSE MEDICAL PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD STE 200
PULLMAN WA
99163-5537
US

IV. Provider business mailing address

825 SE BISHOP BLVD STE 200
PULLMAN WA
99163-5537
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-2517
  • Fax: 509-334-9247
Mailing address:
  • Phone: 509-332-2517
  • Fax: 509-334-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE M FOSBACK
Title or Position: PRESIDENT
Credential: MD
Phone: 509-332-2517