Organization
POCATELLO HEALTH SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN C. PETROVICH (EVP, GENERAL COUNSEL)
(615) 296-3594
Entity
Organization
Contact information
Practice address
2240 E CENTER ST, POCATELLO, ID 83201-2600
(208) 233-2100
(208) 233-3146
Mailing address
1 BURTON HILLS BLVD STE 250, NASHVILLE, TN 37215-6195
(615) 296-3594
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
12/07/2021
Last updated
12/07/2021
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