Provider Demographics
NPI:1346263308
Name:COMMUNITY HEALTHCARE OF THE PALOUSE
Entity Type:Organization
Organization Name:COMMUNITY HEALTHCARE OF THE PALOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:SPADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-892-1346
Mailing Address - Street 1:PO BOX 3509
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-2517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:619 S WASHINGTON ST
Practice Address - Street 2:STE 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:2006-07-25
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1061589Medicaid
ID1120820Medicare ID - Type Unspecified
WA1061589Medicaid
WAGAB16367Medicare PIN