Organization
CLEARWATER VALLEY HOSPITAL & CLINIC INC
Active
Other names
Kooskia Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY BARKER (COO)
(208) 476-4555
Entity
Organization
Contact information
Practice address
301 CEDAR ST, OROFINO, ID 83544-9029
(208) 476-4555
(208) 476-5385
Mailing address
201 THENON ST, KOOSKIA, ID 83539
(208) 926-7801
(208) 926-4721
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805060900
—
ID
Enumeration date
06/03/2006
Last updated
04/22/2008
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