MEDICARE: CONFLUENCE SLEEP & PULMONARY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DF4584	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010158930	OTHER	ID	REGENCE BLUESHIELD
2	0215165	OTHER	WA	LABOR & INDUSTRIES
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	B5650	OTHER	ID	BLUE CROSS OF IDAHO

General Provider Information

NPI Number	:	1124135165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONFLUENCE SLEEP & PULMONARY LLC

Provider Business Mailing Address
First Line	:	307 SAINT JOHNS WAY
Second Line	:	SUITE 16
City	:	LEWISTON
State	:	ID
Zip	:	83501-2435
Country	:	US
Telephone Number	:	208-746-8600
Fax Number	:	208-746-8604

Provider Business Practice Location Address
First Line	:	307 SAINT JOHNS WAY
Second Line	:	SUITE 16
City	:	LEWISTON
State	:	ID
Zip	:	83501-2435
Country	:	US
Telephone Number	:	208-746-8600
Fax Number	:	208-746-8604

Authorized Official
Title or Position	:	OWNER
Name	:	LUKE A PLUTO
Credential	:	M.D.
Telephone Number	:	208-746-8600

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	10/19/2011

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Directions to “CONFLUENCE SLEEP & PULMONARY LLC ” Practice Location

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