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Organization

POCATELLO CHILDREN'S CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. JESSICA PERRY (ADMINISTRATOR)
(208) 236-9600
Entity
Organization

Contact information

Practice address
500 S 11TH AVE, STE 204, POCATELLO, ID 83201-4835
(208) 232-1443
(208) 239-3434
Mailing address
PO BOX 4730, POCATELLO, ID 83205-4730
(208) 232-1443
(208) 239-3434

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
807621700
ID
Enumeration date
02/26/2008
Last updated
02/26/2008
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