Organization
PORTNEUF NEPHROLOGY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JAN M JACOBS (ACCOUNTS RECEIVABLE MANAGER)
(208) 367-3076
Entity
Organization
Contact information
Practice address
2001 BENCH RD, POCATELLO, ID 83201-2033
(208) 637-1090
(208) 637-1097
Mailing address
5610 GAGE ST, BOISE, ID 83706-1332
(208) 367-3076
(208) 367-6909
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
BM7847203
ID
Other
Enumeration date
11/02/2005
Last updated
08/22/2020
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