Idaho Dept Of Health & Welfare Reg 6 Amh Psr Poc

NPI 1225169139 - Clinic/Center - 261QM0801X

NPI Details
NPI 1225169139
Enumeration Date 03/09/2007
Last Updated 07/08/2007
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name ED ED
Position PROGRAM MANAGER
Phone (208) 234-7900
Fax (208) 236-6328
Practice Location
421 MEMORIAL DR
POCATELLO ID, 83201-4008, US
Phone (208) 234-7900
Fax (208) 236-6328
Business Location
421 MEMORIAL DR
POCATELLO ID, 83201-4008, US
Phone (208) 234-7900
Fax (208) 236-6328
Toxanomy
Taxonomy Code 261QM0801X
License State
License Number
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According to our database, Idaho Dept Of Health & Welfare Reg 6 Amh Psr Poc NPI is 1225169139, taxonomy code is 261QM0801X Idaho Dept Of Health & Welfare Reg 6 Amh Psr Poc physically located at 421 Memorial Dr, Pocatello ID, 83201-4008. NPI Number 1033115704 has the healthcare provider type.

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1225169139 NPI number is provided on an as is basis without warranty of any kind. 1225169139 is maintained by the National Plan & Provider Enumeration System. The contents of Idaho Dept Of Health & Welfare Reg 6 Amh Psr Poc are for informational purposes only.