Active NPI
Glenn David Rych, MD
- Family Medicine Physician
- Moscow, ID
National Provider Identifier
1013981604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M4592
- Practice address
- 623 S Main St
Moscow, ID 83843-2983 - Phone
- (208) 882-2011
- Fax
- (208) 883-1853
- NPI assigned
- Feb 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M4592 | ID | Primary |
Addresses
Primary practice location
623 S Main St
Moscow, ID 83843-2983
Mailing address
623 S Main St
Moscow, ID 83843-2983
Phone (208) 882-2011
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M4592 | ID | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191456000000",
"number": "1013981604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "623 S MAIN ST",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838432983",
"telephone_number": "208-882-2011",
"fax_number": "208-883-1853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "623 S MAIN ST",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838432983",
"telephone_number": "208-882-2011",
"fax_number": "208-883-1853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYCH",
"first_name": "GLENN",
"middle_name": "DAVID",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-13",
"last_updated": "2007-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "M4592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moscow, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.