Provider Demographics
NPI:1548667421
Name:PALOUSE SPECIALTY PHYSICIANS, P.S.
Entity type:Organization
Organization Name:PALOUSE SPECIALTY PHYSICIANS, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:FORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-332-2541
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-0847
Mailing Address - Country:US
Mailing Address - Phone:509-332-6139
Mailing Address - Fax:509-332-6579
Practice Address - Street 1:825 SE BISHOP BLVD
Practice Address - Street 2:SUITE 501
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5517
Practice Address - Country:US
Practice Address - Phone:509-332-6139
Practice Address - Fax:509-332-6579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty