Organization
GRITMAN MEDICAL CENTER, INC.
Active
Parent organization
GRITMAN MEDICAL CENTER, INC.
Other names
Moscow Family Medicine Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRITMAN MEDICAL CENTER, INC.
Authorized official
MRS. DANIELLE LYNAS (CFO)
(208) 883-2220
Entity
Organization
Contact information
Practice address
623 S MAIN ST STE 1, MOSCOW, ID 83843-3042
(208) 882-2011
(208) 883-1853
Mailing address
700 S MAIN ST, MOSCOW, ID 83843-3046
(208) 882-4511
(208) 883-6580
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39
STATE OF IDAHO LICENSE
ID
Enumeration date
10/05/2018
Last updated
10/15/2018
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