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Organization
POCATELLO HEALTH SERVICES, LLC
Active
Organization
POCATELLO HEALTH SERVICES, LLC
Active
Other names
Portneuf Medical Practices
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN E ABREU (CFO)
(208) 239-1020
Entity
Organization
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-2065
(208) 239-3754
Mailing address
PO BOX 4168, POCATELLO, ID 83205-4168
(208) 239-2065
(208) 239-3754
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
12
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808437000
—
ID
Enumeration date
06/26/2009
Last updated
04/18/2012
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