Organization
PALOUSE SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN NEEDHAM (OFFICE MANAGER)
(208) 883-1500
Entity
Organization
Contact information
Practice address
2300 W A ST, MOSCOW, ID 83843-4038
(208) 883-1500
(208) 882-7701
Mailing address
2300 W A ST, MOSCOW, ID 83843-4038
(208) 883-1500
(208) 882-7701
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1870569
MEDICARE PTAN
ID
05
—
806919900
—
ID
Enumeration date
06/20/2005
Last updated
02/13/2024
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