Provider Demographics
NPI:1972900546
Name:LEWIS-CLARK STATE COLLEGE
Entity type:Organization
Organization Name:LEWIS-CLARK STATE COLLEGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FOR FINANCE AND ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:CHET
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-792-2240
Mailing Address - Street 1:500 8TH AVE
Mailing Address - Street 2:SAM GLENN COMPLEX 205
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2691
Mailing Address - Country:US
Mailing Address - Phone:208-792-2251
Mailing Address - Fax:208-792-2882
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:83501-2691
Practice Address - Country:US
Practice Address - Phone:208-792-2251
Practice Address - Fax:208-792-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health