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General NPI Number Information
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NPI Number | 1043492655
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTH PHYSICIAN GROUP LLC
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 619 S WASHINGTON ST SUITE 203
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City | MOSCOW
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State | ID
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Zip | 83843-3090
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Country | US
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Telephone | 208-892-1346
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Fax | 208-892-8306
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Provider Business Mailing Address
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Address Line | 619 S WASHINGTON ST STE 203
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City | MOSCOW
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State | ID
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Zip | 83843-3063
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Country | US
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Telephone | 208-892-1346
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Fax | 208-892-8306
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT N SPADY
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Credential | M.D.
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Telephone | 208-892-1346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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