Provider Demographics
NPI:1184347445
Name:NORTH IDAHO INTERNAL MEDICINE
Entity type:Organization
Organization Name:NORTH IDAHO INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-382-4281
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:MOYIE SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83845-0652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1589 PERKINS LAKE RD
Practice Address - Street 2:
Practice Address - City:MOYIE SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83845-5103
Practice Address - Country:US
Practice Address - Phone:760-382-4281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty