Organization
MAGIC VALLEY REGIONAL MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS JOHN PERIUS PA-C (PHYSICIAN ASSISTANT)
(208) 737-2112
Entity
Organization
Contact information
Practice address
650 ADDISON AVE W, TWIN FALLS, ID 83301-5444
(208) 737-2112
Mailing address
2519 E 2519 N, TWIN FALLS, ID 83301
(208) 735-1628
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
PA 258
ID
Other
Enumeration date
04/05/2006
Last updated
08/22/2020
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