# STATE OF IDAHO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southeastern District Health Department
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821129420
- **Authorized official:** MR. EDWARD A. MARUGG R.E.H.S. (DIRECTOR)
- **Authorized official phone:** (208) 233-9080

## Contact information

- **Practice address:** 1901 ALVIN RICKEN DR, POCATELLO, ID 83201-2727
- **Practice address phone:** (208) 239-5242
- **Practice address fax:** (208) 478-9297
- **Mailing address:** 1901 ALVIN RICKEN DR, POCATELLO, ID 83201-2727
- **Mailing address phone:** (208) 239-5242
- **Mailing address fax:** (208) 478-9297

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 03/08/2007
- **Last updated:** 07/10/2008