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Organization
HEALTH WEST
Active
Organization
HEALTH WEST
Active
Parent organization
ISU RESDENCY
Organization subpart
Yes
Provider details
NPI number
Legal business name
ISU RESDENCY
Authorized official
JEREMY SMUIN (INFORMATION SPECIALIST)
(208) 232-7862
Entity
Organization
Contact information
Practice address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 234-4700
Mailing address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 234-4700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MRM-1500
ID
Other
Enumeration date
07/10/2015
Last updated
08/14/2015
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