Provider Demographics
NPI:1588413694
Name:GRITMAN MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:GRITMAN MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-883-6456
Mailing Address - Street 1:623 S MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2983
Mailing Address - Country:US
Mailing Address - Phone:208-883-2224
Mailing Address - Fax:208-882-6580
Practice Address - Street 1:500 8TH AVE
Practice Address - Street 2:SAM GLENN COMPLEX #205
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:208-792-2251
Practice Address - Fax:208-792-2882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRITMAN MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty