Healthcare Provider Details

I. General information

NPI: 1760889265
Provider Name (Legal Business Name): PALOUSE SPECIALTY PHYSICIANS, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD SUITE 601
PULLMAN WA
99163-5517
US

IV. Provider business mailing address

PO BOX 847
PULLMAN WA
99163-0847
US

V. Phone/Fax

Practice location:
  • Phone: 509-334-5876
  • Fax: 509-332-8793
Mailing address:
  • Phone: 509-332-6139
  • Fax: 509-332-6579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: SACHA L SMITH
Title or Position: DIR OF OPERATIONS
Credential:
Phone: 509-332-3488