Organization
RIVER HORSE MEDICAL CLINIC
Active
Other names
River Horse Medical Clinic, Pllc
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER GRINAGE PA-C (OWNER/CEO)
(208) 792-1011
Entity
Organization
Contact information
Practice address
222 SOUTHWAY AVE STE C, LEWISTON, ID 83501-2703
(208) 792-1011
(208) 616-1453
Mailing address
PO BOX 225, LEWISTON, ID 83501-0225
(208) 792-1011
(208) 616-1453
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396151395
PROVIDER NPI
—
Enumeration date
09/17/2024
Last updated
11/14/2024
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