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Organization
MAAG PRESCRIPTION CENTER L.L.C.
Active
Organization
MAAG PRESCRIPTION CENTER L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TROY PAZ (GM)
(208) 233-2063
Entity
Organization
Contact information
Practice address
333 W CENTER ST, POCATELLO, ID 83204-3243
(208) 233-2063
Mailing address
PO BOX 115, POCATELLO, ID 83204-0115
(208) 233-2063
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
526CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010014150
BLUE SHIELD OF ID
ID
01
—
8589-4
BLUE CROSS OF IDAHO
ID
Enumeration date
02/06/2007
Last updated
08/22/2020
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