NPI age
18 years
Enumerated 2007-08-24
Across 3 active clinic/center providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 807346000 | |
| 01 (ID) | 1369188 | MEDICARE PROVIDER |
| 01 | D08608980 | MEDICARE DME SUBITTER ID |
| 01 (ID) | P-2428 | BLUE CROSS |
| 01 (ID) | P2427 | BLUE CROSS |
Single-site organization. Only one practice location on file.
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