Provider Demographics
NPI:1043492655
Name:TOTAL HEALTH PHYSICIAN GROUP LLC
Entity Type:Organization
Organization Name:TOTAL HEALTH PHYSICIAN GROUP LLC
Other - Org Name:HEALTHMOTIVATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:SPADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-892-1346
Mailing Address - Street 1:619 S WASHINGTON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3063
Mailing Address - Country:US
Mailing Address - Phone:208-892-1346
Mailing Address - Fax:208-892-8306
Practice Address - Street 1:619 S WASHINGTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3090
Practice Address - Country:US
Practice Address - Phone:208-892-1346
Practice Address - Fax:208-892-8306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1370074Medicare PIN