Organization Name: | NORTHWEST HOSPICE LLC, DBA SIGNATURE PRIMARY CARE |
NPI Number: | 1215398797 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT THOMAS (PRESIDENT) |
Mailing Address: | 2480 Highway 52 Payette |
State: | ID US |
Postal Code: | 836615536 |
Phone Number: | 2086429222 |
Fax Number: | 2086429224 |
NPI Enumeration Date: | 03/11/2016 |
NPI Last Update Date: | 05/27/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |