| Idaho Sleep And Neurology, Pllc | |
|
1825 S Kimball Ave Caldwell ID 83605-4828 | |
| (208) 454-0567 | |
| (208) 402-6635 |
| Full Name | Idaho Sleep And Neurology, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 1825 S Kimball Ave, Caldwell, Idaho |
| Authorized Official Name and Position | Wade S Harris (OWNER) |
| Authorized Official Contact | 2084540567 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Sleep And Neurology, Pllc 1825 S Kimball Ave Caldwell ID 83605-4828 Ph: (208) 454-0567 | Idaho Sleep And Neurology, Pllc 1825 S Kimball Ave Caldwell ID 83605-4828 Ph: (208) 454-0567 |
| NPI Number | 1902220411 |
|---|---|
| Provider Enumeration Date | 02/05/2014 |
| Last Update Date | 02/13/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902220411 | NPI | - | NPPES |
| 1063585305 | Other | ID | NPI |
| 807637500 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | M9670 (Idaho) | Primary |
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