# MOUNTAIN HEALTH SERVICES PC

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

## Provider details

- **NPI number:** 1164539912
- **Authorized official:** FREDERICK R HALLER M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (208) 783-1267

## Contact information

- **Practice address:** 740 MCKINLEY AVE, KELLOGG, ID 83837-2693
- **Practice address phone:** (208) 783-1267
- **Practice address fax:** (208) 786-4471
- **Mailing address:** 740 MCKINLEY AVE, KELLOGG, ID 83837-2693
- **Mailing address phone:** (208) 783-1267
- **Mailing address fax:** (208) 786-4471

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | M8355 | ID | Yes |

## Other

- **Enumeration date:** 08/25/2006
- **Last updated:** 02/14/2013