| |
777 Hospital Way Pocatello ID 83201-2753 | |
(801) 507-3500 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 777 Hospital Way, Pocatello, Idaho |
Authorized Official Name and Position | Kelly J Howard (DIRECTOR) |
Authorized Official Contact | 8014421425 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 27128 Salt Lake City UT 84127-0128 Ph: (801) 507-3533 | 777 Hospital Way Pocatello ID 83201-2753 Ph: (801) 507-3500 |
NPI Number | 1073747929 |
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Provider Enumeration Date | 05/06/2009 |
Last Update Date | 05/06/2009 |
Identifier | Type | State | Issuer |
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1073747929 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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