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General NPI Number Information
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NPI Number | 1205720232
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Entity Type | Organization
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Legal Business Name | GRITMAN MEDICAL CENTER INC
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 719 S MAIN ST STE 1
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City | MOSCOW
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State | ID
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Zip | 83843-3041
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Country | US
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Telephone | 208-882-3092
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Fax | 208-883-6550
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Provider Business Mailing Address
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Address Line | PO BOX 8007
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City | MOSCOW
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State | ID
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Zip | 83843-0507
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Country | US
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Telephone | 208-882-8812
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Fax | 208-892-3714
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Authorized Official
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Title or Position | CEO AND PRESIDENT
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Name | MRS. KARA BESST
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Credential |
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Telephone | 208-883-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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