# SOUTHEASTERN DISTRICT HEALTH DEPARTMENT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023250966
- **Authorized official:** KIM L. BARRERA (MEDICA RECORDS EXAMINER)
- **Authorized official phone:** (208) 239-5278

## Contact information

- **Practice address:** 1901 ALVIN RICKEN DR, POCATELLO, ID 83201-2727
- **Practice address phone:** (208) 233-9080
- **Practice address fax:** (208) 234-7169
- **Mailing address:** 1901 ALVIN RICKEN DR, POCATELLO, ID 83201-2727
- **Mailing address phone:** (208) 233-9080
- **Mailing address fax:** (208) 234-7169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 03/24/2009
- **Last updated:** 03/24/2009