# INDIGO IDAHO SERVICES, LLC

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

## Provider details

- **NPI number:** 1821799263
- **Authorized official:** WILLIAM ROBERTSON (PRESIDENT)
- **Authorized official phone:** (253) 403-1272

## Contact information

- **Practice address:** 2836 N RAMSEY RD, COEUR D ALENE, ID 83815-9002
- **Practice address phone:** (208) 482-3400
- **Mailing address:** P.O. BOX 5299, MS: 820-5-PCO, TACOMA, WA 98415-0299

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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