Provider Demographics
NPI:1346926144
Name:PHYSICIAN SPECIALISTS NORTHWEST
Entity Type:Organization
Organization Name:PHYSICIAN SPECIALISTS NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:AMES
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:208-400-5131
Mailing Address - Street 1:217 CEDAR STREET #251
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864
Mailing Address - Country:US
Mailing Address - Phone:208-242-2155
Mailing Address - Fax:208-277-3448
Practice Address - Street 1:8950 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4854
Practice Address - Country:US
Practice Address - Phone:208-400-5131
Practice Address - Fax:208-277-3448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty