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Organization
ST JOSEPHS EAR NOSE AND THROAT CLINIC PLLC
Active
Organization
ST JOSEPHS EAR NOSE AND THROAT CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS R DETAR M.D., F.A.C.S. (OWNER/MEMBER)
(208) 777-1320
Entity
Organization
Contact information
Practice address
849 N SYRINGA ST, POST FALLS, ID 83854-8794
(208) 777-1320
(208) 777-1322
Mailing address
849 N SYRINGA ST, POST FALLS, ID 83854-8794
(208) 777-1320
(208) 777-1322
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NULL
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000100006619
REGENCE/ASURIS
ID
01
—
151513
WASHINGTON L&I
ID
05
—
7087273
—
ID
05
—
805084300
—
ID
01
—
8938054
WA L&I CRIME VICTIMS
ID
01
—
8M012
BLUE CROSS OF IDAHO
ID
Enumeration date
05/19/2006
Last updated
02/06/2024
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