Not Tsoo Gah Nee | |
717 Mission Rd Ft Hall ID 83203 | |
(208) 238-5427 | |
Not Available |
Full Name | Not Tsoo Gah Nee |
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Speciality | Clinic/center - Public Health, Federal |
Location | 717 Mission Rd, Ft Hall, Idaho |
Authorized Official Name and Position | Kellie Ann Alcorn (LPN) |
Authorized Official Contact | 2082385427 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Not Tsoo Gah Nee Po Box 717 Mission Rd Ft Hall ID 83203 Ph: (208) 238-5427 | Not Tsoo Gah Nee 717 Mission Rd Ft Hall ID 83203 Ph: (208) 238-5427 |
NPI Number | 1366801458 |
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Provider Enumeration Date | 02/17/2016 |
Last Update Date | 02/17/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366801458 | NPI | - | NPPES |
003398900 | Medicaid | ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP0904X | Clinic/center - Public Health, Federal | PN-15140 (Idaho) | Primary |