Organization
MOSCOW MEDICAL, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY CORNISH (BILLING MANAGER)
(208) 746-3653
Entity
Organization
Contact information
Practice address
213 N MAIN ST, MOSCOW, ID 83843-2700
(208) 882-7565
Mailing address
213 N MAIN ST, MOSCOW, ID 83843-2700
(208) 882-7565
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002262200
—
ID
01
—
133858
MEDICARE RHC
ID
Enumeration date
01/19/2007
Last updated
03/31/2009
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