Provider Demographics
NPI:1750386256
Name:PALOUSE SURGERY CENTER, LLC
Entity type:Organization
Organization Name:PALOUSE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEEDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-883-1500
Mailing Address - Street 1:2300 W A ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-4038
Mailing Address - Country:US
Mailing Address - Phone:208-883-1500
Mailing Address - Fax:208-882-7701
Practice Address - Street 1:2300 W A ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-4038
Practice Address - Country:US
Practice Address - Phone:208-883-1500
Practice Address - Fax:208-882-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1870569OtherMEDICARE PTAN
ID806919900Medicaid
ID13-C0001051Medicare ID - Type Unspecified