Provider Demographics
NPI:1407852437
Name:PALOUSE HEALTH CENTER, P.S.
Entity Type:Organization
Organization Name:PALOUSE HEALTH CENTER, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:UTE
Authorized Official - Last Name:FUHRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-878-1263
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:PALOUSE
Mailing Address - State:WA
Mailing Address - Zip Code:99161-0475
Mailing Address - Country:US
Mailing Address - Phone:509-878-8000
Mailing Address - Fax:509-878-8008
Practice Address - Street 1:235 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:PALOUSE
Practice Address - State:WA
Practice Address - Zip Code:99161
Practice Address - Country:US
Practice Address - Phone:509-878-8000
Practice Address - Fax:509-878-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7103856Medicaid
WAAB33130Medicare ID - Type Unspecified