# IDAHO STATE UNIVERSITY

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

## Provider details

- **NPI number:** 1578508081
- **Authorized official:** MR. RANDY L. BISHOP M.S. (AUDIOLOGIST)
- **Authorized official phone:** (208) 282-3495

## Contact information

- **Practice address:** 650 MEMORIAL DRIVE, \# 68, POCATELLO, ID 83209-0001
- **Practice address phone:** (208) 282-3495
- **Practice address fax:** (208) 282-4571
- **Mailing address:** 650 MEMORIAL DRIVE, \# 68, POCATELLO, ID 83209-0001
- **Mailing address phone:** (208) 282-3495
- **Mailing address fax:** (208) 282-4571

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | AUD1225 | ID | Yes |

## Other

- **Enumeration date:** 06/18/2006
- **Last updated:** 08/22/2020