Provider Demographics
NPI:1932412103
Name:PALOUSE-CLEARWATER NEUROLOGY, P.A.
Entity Type:Organization
Organization Name:PALOUSE-CLEARWATER NEUROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-882-1777
Mailing Address - Street 1:619 S WASHINGTON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3090
Mailing Address - Country:US
Mailing Address - Phone:208-882-1777
Mailing Address - Fax:208-882-7006
Practice Address - Street 1:619 S WASHINGTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3090
Practice Address - Country:US
Practice Address - Phone:208-882-1777
Practice Address - Fax:208-882-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM62192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM0027067Medicaid
WA8146342Medicaid
WAAB08640Medicare PIN
ID1127393Medicare PIN
IDM0027067Medicaid