State of Idaho Department of Health and Welfare

NPI #1538225545 in Blackfoot, Idaho

Provider Information

NPI Number: 1538225545
Entity Type: Organization
Organization Name: State of Idaho Department of Health and Welfare
Subpart: Yes (part of a larger organization)
Parent Organization: STATE HOSPITAL SOUTH
Primary Specialty: Clinic/Center
Enumeration Date: Dec 28, 2006
Last Updated: Jul 15, 2016

Practice Location

Address: 700 E. ALICE
Address 2: BOX 400
City: Blackfoot
State: Idaho
ZIP Code: 83221-0400
Phone: (208) 785-1200

Authorized Official

Name: LYNN D SHIELDS
Title: PATIENT ACCOUNTS SPECIALIST
Phone: (208) 785-8462

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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