Pullman Regional Hospital Clinic Network LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

13-3860 Issued in ID

Legal business name

PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC

Doing business as

Palouse Pediatrics - Moscow

Practice address

1420 S Blaine St Ste 5
Moscow, ID 83843-3973

Phone

(208) 882-2247

Fax

(509) 336-7482

NPI assigned

Dec 1, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Grover 'Pete' C Peters III

Title

Clinic Administrator

Phone

(509) 332-6139

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Palouse Pediatrics - Moscow Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435276800000",
    "number": "1205104593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 SE BISHOP BLVD STE 101",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991635502",
            "telephone_number": "509-332-6139",
            "fax_number": "509-332-6579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 S BLAINE ST STE 5",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838433973",
            "telephone_number": "208-882-2247",
            "fax_number": "509-336-7482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-01",
        "last_updated": "2015-06-26",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "GROVER 'PETE'",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "509-332-6139",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "ID",
            "license": "13-3860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS CERTIFICATION",
            "identifier": "13-3860",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "1369068",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palouse Pediatrics - Moscow",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sheila Lynn Price, FNP-C
• Sam Primozich
• Logan Frederick Prins
• Public Hospital District #1-a of Whitman County (Palouse Pediatrics)
• Jace Patrick Puckett
• Latifa Qayoum, PHARM. D.
• Quality Chiropractic Center PLLC
• Claire Qualls, EMT
• R & B Anesthesia PLLC
• Sophia Elizabeth Raabe

• Rural Health Clinic/Center in Moscow, ID
• Providers in Moscow, ID by specialty
• Rural Health Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.