Patrick Glascock, R.T. (R)
Individual provider Active NPI Radiography Radiologic Technologist · Rathdrum, ID
NPI 1316360985 · NPPES record last updated Jan 31, 2014
Key facts
- NPI
- 1316360985
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Radiography Radiologic Technologist 2471C3402X
- License
- RT 60406832 (WA)
- Practice address
- 5260 W Hayden Ave
Rathdrum, ID 83858-9467 - Phone
- (208) 660-5943
- NPI assigned
- Jan 31, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 914469 | OR | MD | Radiography Radiologic Technologist |
| RT 60406832 | WA | MD | Radiography Radiologic Technologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiography Radiologic Technologist | 2471C3402X | 914469 | OR | |
| Radiography Radiologic Technologist | 2471C3402X | RT 60406832 | WA | Yes |
Addresses
Primary practice location
5260 W Hayden Ave
Rathdrum, ID 83858-9467
Mailing address
1920 W Canfield Ave
Coeur D Alene, ID 83815-0413
Phone (208) 640-1693
Other providers in Rathdrum, ID
- Fulfilling Hope Human Services LLC
- Angela Gallatin
- Chris J Garrett
- Generations Assisted Living and Wellness Inc
- Amanda Jean Geraets
- Christopher Paul Greiner
- Shari Griff
- Steven Brett Hall
- Kimberly M Hanna
- Happy 2B Home LLC
All providers in Rathdrum, ID · Radiography Radiologic Technologist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.