STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE
Organization (NPI-2)
Active
Clinic/Center
Provider Information
- NPI Number
1538225545- Provider Type
- Organization / Facility (NPI-2)
- Status
- Active
Contact & Location
- Address
- 700 E. ALICE BOX 400, BLACKFOOT, ID, 832210400
- Phone
- (208) 785-1200
- Fax
- (208) 785-8518
Specialties & Taxonomies
Clinic/Center
Primary License: ID #17