# C SCOTT NEEDHAM MD PLLC

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

## Provider details

- **NPI number:** 1467053090
- **Authorized official:** CHARLES SCOTT NEEDHAM MD (OWNER)
- **Authorized official phone:** (406) 690-2008

## Contact information

- **Practice address:** 2805 VALENCIA DR, IDAHO FALLS, ID 83404-7597
- **Practice address phone:** (208) 525-9400
- **Mailing address:** 2805 VALENCIA DR, IDAHO FALLS, ID 83404-7597

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/02/2020
- **Last updated:** 11/02/2020