IDAHO STATE UNIVERSITY HEALTH CENTER NPI 1336214618

NPI Information

IDAHO STATE UNIVERSITY HEALTH CENTER is a student health clinic center in Pocatello, ID. IDAHO STATE UNIVERSITY HEALTH CENTER NPI is 1336214618. The provider is registered as an organization entity type.

The provider's business location address is:

990 CESAR CHAVEZ AVE
POCATELLO, ID
ZIP 83209-001
Phone: (208) 282-2330
Fax: (208) 282-4036

The provider's authorized official is Ronald M Solbrig .
The authorized official title is Director and has the following contact phone number (208) 282-2330.

The CLIA number assigned to this NPI record is 13D0665964 - school/student health service with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 11/21/2006 and was last updated on 2/26/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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