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Organization
INDIGO IDAHO SERVICES, LLC
Active
Organization
INDIGO IDAHO SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM ROBERTSON (PRESIDENT)
(253) 403-1272
Entity
Organization
Contact information
Practice address
2836 N RAMSEY RD, COEUR D ALENE, ID 83815-9002
(208) 482-3400
Mailing address
P.O. BOX 5299, MS: 820-5-PCO, TACOMA, WA 98415-0299
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
03/13/2023
Last updated
03/21/2023
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