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NPI Code Detail

MEDICARE: GAGE INPATIENT SERVICES

MEDICARE: GAGE INPATIENT SERVICES
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
1207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DUTD5OTHERIDIDAHO BLUE CROSS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396779328
Entity Type Code : Organization
Provider Name (Legal Business Name) : GAGE INPATIENT SERVICES
Provider Business Mailing Address
First Line : PO BOX 13651
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19101-3651
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1221 HIGHLAND AVE
Second Line :
City : CLARKSTON
State : WA
Zip : 99403-2829
Country : US
Telephone Number : 208-799-5522
Fax Number :
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : DR. ANGEL ISCOVICH
Credential : MD
Telephone Number : 214-712-2403
Provider Enumeration Date : 07/10/2006
Last Update Date : 04/20/2008

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Directions to “GAGE INPATIENT SERVICES ” Practice Location

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