Organization
GAGE INPATIENT SERVICES
Active
Organization
GAGE INPATIENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGEL ISCOVICH MD (PRESIDENT/OWNER)
(214) 712-2403
Entity
Organization
Contact information
Practice address
1221 HIGHLAND AVE, CLARKSTON, WA 99403-2829
(208) 799-5522
Mailing address
PO BOX 13651, PHILADELPHIA, PA 19101-3651
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7134851
—
WA
01
—
DUTD5
IDAHO BLUE CROSS
ID
Enumeration date
07/10/2006
Last updated
04/20/2008
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