STATE OF IDAHO NPI 1902995814

NPI Information

NPI: 1902995814
Provider Name: STATE OF IDAHO

Doing Business As: SOUTHEASTERN DISTRICT HEALTH DEPARTMENT

Classification: Hospice Care, Community Based - 251G00000X
Entity Type: Organization
Address:
1901 ALVIN RICKEN DR
POCATELLO, ID
ZIP 83201
Phone: (208) 239-5240
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STATE OF IDAHO is a hospice care community based in Pocatello, ID. STATE OF IDAHO NPI is 1902995814. The provider is registered as an organization entity type.
The provider Is Doing Business As Southeastern District Health Department.

The provider's business location address is:

1901 ALVIN RICKEN DR
POCATELLO, ID
ZIP 83201-727
Phone: (208) 239-5240
Fax: (208) 478-6306

The provider's authorized official is Edward A. Marugg .
The authorized official title is District Director and has the following contact phone number (208) 233-9080.

The enumeration date for this NPI number is 10/11/2006 and was last updated on 8/22/2020.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251G00000X	Hospice Care, Community Based		13-1512	IDAHO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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