# IDAHO SLEEP AND NEUROLOGY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Idaho Sleep and Neurology PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063585305
- **Authorized official:** LANCE HALE (PRACTICE MANAGER)
- **Authorized official phone:** (208) 454-0567

## Contact information

- **Practice address:** 211 E LOGAN ST, SUITE 105, CALDWELL, ID 83605-4882
- **Practice address phone:** (208) 454-0567
- **Practice address fax:** (208) 454-0965
- **Mailing address:** 211 E LOGAN ST, SUITE 105, CALDWELL, ID 83605-4882
- **Mailing address phone:** (208) 454-0567
- **Mailing address fax:** (208) 454-0965

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | — | ID | Yes |

## Other

- **Enumeration date:** 11/16/2006
- **Last updated:** 12/27/2011