Provider Demographics
NPI:1124135165
Name:CONFLUENCE SLEEP & PULMONARY LLC
Entity type:Organization
Organization Name:CONFLUENCE SLEEP & PULMONARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLUTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-746-8600
Mailing Address - Street 1:307 SAINT JOHNS WAY
Mailing Address - Street 2:SUITE 16
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2435
Mailing Address - Country:US
Mailing Address - Phone:208-746-8600
Mailing Address - Fax:208-746-8604
Practice Address - Street 1:307 SAINT JOHNS WAY
Practice Address - Street 2:SUITE 16
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2435
Practice Address - Country:US
Practice Address - Phone:208-746-8600
Practice Address - Fax:208-746-8604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010158930OtherREGENCE BLUESHIELD
WA0215165OtherLABOR & INDUSTRIES
WA1123389Medicaid
DF4584OtherRAILROAD MEDICARE
ID804124700Medicaid
IDB5650OtherBLUE CROSS OF IDAHO
WAG8862337Medicare PIN
WA0215165OtherLABOR & INDUSTRIES
DF4584OtherRAILROAD MEDICARE