Organization
LEWIS CLARK GASTROENTEROLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA LYNN SMITH RN (CLINICAL DIRECTOR)
(208) 298-3002
Entity
Organization
Contact information
Practice address
1630 23RD AVE, SUITE 701, LEWISTON, ID 83501-6350
(208) 298-3002
(208) 298-7433
Mailing address
1630 23RD AVE, SUITE 701, LEWISTON, ID 83501-6350
(208) 298-3002
(208) 298-7433
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806979100
—
ID
Enumeration date
10/17/2005
Last updated
10/12/2012
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