Organization
EASTERN IDAHO REG MED CTR PS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT ENGLAND (VP)
(208) 529-7147
Entity
Organization
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 529-7147
Mailing address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 529-7147
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8L006
BLUE CROSS OF IDAHO
ID
Enumeration date
06/09/2006
Last updated
08/28/2007
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