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General NPI Number Information
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NPI Number | 1386457125
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Entity Type | Organization
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Legal Business Name | PNW MEDICAL GROUP LLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 497 S BECK RD
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City | POST FALLS
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State | ID
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Zip | 83854-4891
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Country | US
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Telephone | 208-618-6911
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Fax |
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Provider Business Mailing Address
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Address Line | 1940 E GUNTHER AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83815-9435
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. KYLE SEVERINSEN
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Credential | MD
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Telephone | 801-205-9647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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