# PATHOLOGY ASSOCIATES OF IDAHO FALLS P A

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

## Provider details

- **NPI number:** 1497723241
- **Authorized official:** MATT TANNENBAUM MD (PRESIDENT)
- **Authorized official phone:** (208) 529-6050

## Contact information

- **Practice address:** 3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
- **Practice address phone:** (208) 529-6050
- **Mailing address:** 3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
- **Mailing address phone:** (208) 529-6111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | NULL | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/09/2006
- **Last updated:** 03/06/2020