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Organization

CLEARWATER MEDICAL CENTER PLLC

Active
Other names
Clearwater Medical Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CELSO R CHAVEZ MD (OWNER PHYSICIAN)
(208) 743-8416
Entity
Organization

Contact information

Practice address
1522 17TH ST, LEWISTON, ID 83501-3652
(208) 743-8416
(208) 743-4642
Mailing address
1522 17TH ST, LEWISTON, ID 83501-3652
(208) 743-8416
(208) 743-4642

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
A87025
ID
363LF0000X
Family Nurse Practitioner
Primary
NP361A
363LF0000X
Family Nurse Practitioner
NP372A
ID
363LF0000X
Family Nurse Practitioner
NP388A
ID
363LF0000X
Family Nurse Practitioner
NP390A
ID
363LF0000X
Family Nurse Practitioner
NP740A
ID
363LF0000X
Family Nurse Practitioner
NP751A
ID

Other

Enumeration date
09/27/2006
Last updated
12/16/2008
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