Organization
PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC
Active
Other names
Palouse Pediatrics - Pullman
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN FEBUS (CFO)
(509) 332-6139
Entity
Organization
Contact information
Practice address
1205 SE PRO MALL BLVD STE 104, PULLMAN, WA 99163-5423
(509) 332-6139
(509) 332-6579
Mailing address
840 SE BISHOP BLVD STE 101, PULLMAN, WA 99163-5502
(509) 332-6139
(509) 332-6579
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
WA
207RC0000X
Cardiovascular Disease Physician
—
WA
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
50-3922
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50-3922
CMS CERTIFICATION
WA
01
—
G8891113
MEDICARE PTAN
WA
Enumeration date
05/04/2009
Last updated
09/20/2017
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