Provider Demographics
NPI:1518009562
Name:PALOUSE SURGEONS, LLC
Entity Type:Organization
Organization Name:PALOUSE SURGEONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:STILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:208-882-0740
Mailing Address - Street 1:825 SE BISHOP BLVD STE 601
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5517
Mailing Address - Country:US
Mailing Address - Phone:208-882-0740
Mailing Address - Fax:208-882-0981
Practice Address - Street 1:825 SE BISHOP BLVD STE 601
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5517
Practice Address - Country:US
Practice Address - Phone:208-882-0740
Practice Address - Fax:208-882-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID00001050545OtherREGENCE BLUE SHIELD
WA7128275Medicaid
WA7128275Medicaid
WA8854561Medicare ID - Type Unspecified