NPI age
20 years
Enumerated 2005-09-13
Across 99 active clinic/center providers in Idaho.
1 individual provider on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 611193000 | OWCP |
| 05 (ID) | 806919700 | |
| 01 (ID) | 04606 | IBC |
| 01 (ID) | 0198920 | WLI |
| 01 (ID) | 7124381 | WWL |
| 01 (ID) | 3570555 | TRICARE |
| 01 (ID) | 000010146573 | RBS |
Multi-provider organization. 1 individual provider on file at this primary address.
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