Provider Demographics
NPI:1710218839
Name:PULLMAN REGIONAL HOSPITAL CLINIC NETWORK, LLC
Entity Type:Organization
Organization Name:PULLMAN REGIONAL HOSPITAL CLINIC NETWORK, LLC
Other - Org Name:PALOUSE ENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GROVER (PETE)
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:509-336-7647
Mailing Address - Street 1:825 SE BISHOP BLVD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5517
Mailing Address - Country:US
Mailing Address - Phone:509-334-5876
Mailing Address - Fax:509-332-8793
Practice Address - Street 1:825 SE BISHOP BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5517
Practice Address - Country:US
Practice Address - Phone:509-334-5876
Practice Address - Fax:509-332-8793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty