Organization
SOUTHEASTERN DISTRICT HEALTH DEPARTMENT
Active
Organization
SOUTHEASTERN DISTRICT HEALTH DEPARTMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM L. BARRERA (MEDICA RECORDS EXAMINER)
(208) 239-5278
Entity
Organization
Contact information
Practice address
1901 ALVIN RICKEN DR, POCATELLO, ID 83201-2727
(208) 233-9080
(208) 234-7169
Mailing address
1901 ALVIN RICKEN DR, POCATELLO, ID 83201-2727
(208) 233-9080
(208) 234-7169
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808287500
—
ID
Enumeration date
03/24/2009
Last updated
03/24/2009
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