NPI age
19 years
Enumerated 2006-12-29
Across 16 active clinic/center providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 00010146760 | REGENCE |
| 01 (ID) | 8J133 | BLUE CROSS |
Single-site organization. Only one practice location on file.
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