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Organization
JUMP START PEDIATRICS
Active
Organization
JUMP START PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BECCA FAHEY (OFFICE MANAGER)
(208) 664-2468
Entity
Organization
Contact information
Practice address
411 W HAYCRAFT AVE STE D4, COEUR D ALENE, ID 83815-8104
(206) 664-2468
Mailing address
411 W HAYCRAFT AVE STE D4, COEUR D ALENE, ID 83815-8104
Taxonomy
Speciality
Code
Description
License number
State
251X00000X
Supports Brokerage Agency
Primary
OT-1455
ID
Other
Enumeration date
05/11/2015
Last updated
05/11/2015
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