| Easy Go Express | |
|
3551 W Antelope Rd Moore ID 83255-8754 | |
| (208) 680-5339 | |
| Not Available |
| Full Name | Easy Go Express |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 3551 W Antelope Rd, Moore, Idaho |
| Authorized Official Name and Position | Douglas Alma Pearson (OWNER/OPERATOR) |
| Authorized Official Contact | 2086805339 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Easy Go Express 3551 W Antelope Rd Moore ID 83255-8754 Ph: (208) 680-5339 | Easy Go Express 3551 W Antelope Rd Moore ID 83255-8754 Ph: (208) 680-5339 |
| NPI Number | 1336599976 |
|---|---|
| Provider Enumeration Date | 06/14/2016 |
| Last Update Date | 06/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336599976 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (Idaho) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (Idaho) | Primary |