Provider Demographics
NPI:1053387985
Name:POST FALLS INTERNAL MEDICINE AND PEDIATRICS PA
Entity type:Organization
Organization Name:POST FALLS INTERNAL MEDICINE AND PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-773-0721
Mailing Address - Street 1:1300 E MULLAN SUTE 1600
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854
Mailing Address - Country:US
Mailing Address - Phone:208-773-0721
Mailing Address - Fax:208-773-3306
Practice Address - Street 1:1300 E MULLAN SUTE 1600
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854
Practice Address - Country:US
Practice Address - Phone:208-773-0721
Practice Address - Fax:208-773-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3785207R00000X
WA17473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7098353Medicaid
ID1376546Medicare ID - Type Unspecified
A07767Medicare UPIN