1958

NPI #1013306307 in Pocatello, Idaho

Provider Information

NPI Number
1013306307
Entity Type
Organization
Organization Name
1958
Primary Specialty
General Acute Care Hospital - Rural
Enumeration Date
Jan 9, 2015
Last Updated
Jan 9, 2015

Practice Location

Address
730 E CLARK ST
Address 2
#4657
State
Idaho
ZIP Code
83205-5401
Phone
(619) 838-4593

Authorized Official

Name
LORAINE POWELL
Title
REGISTERED NURSE
Phone
(619) 838-4593

Specialties & Taxonomy Codes

Specialty
General Acute Care Hospital - RuralRural

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