| Xl Palliative Care Consultation | |
|
2480 Highway 52 Payette ID 83661-5536 | |
| (208) 642-9222 | |
| (208) 642-9224 |
| Full Name | Xl Palliative Care Consultation |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2480 Highway 52, Payette, Idaho |
| Authorized Official Name and Position | Dwight Erwin Olson (OWNER) |
| Authorized Official Contact | 2086429222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Xl Palliative Care Consultation 57 Grove Rd Ontario OR 97914-8155 Ph: (208) 262-3443 | Xl Palliative Care Consultation 2480 Highway 52 Payette ID 83661-5536 Ph: (208) 642-9222 |
| NPI Number | 1043411861 |
|---|---|
| Provider Enumeration Date | 05/30/2007 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043411861 | NPI | - | NPPES |
| 19523088751 | Other | ID | BUSINESS NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW707 (Idaho) | Primary |
| 1041C0700X | Social Worker - Clinical | LCSW1449 (Oregon) | Secondary |
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