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Organization

CEDAR MOUNTAIN MEDICAL INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. THOMAS PAUL JOHNSON (PRESIDENT)
(208) 777-9199
Entity
Organization

Contact information

Practice address
503 E SELTICE WAY STE 8, POST FALLS, ID 83854-6499
(208) 777-9199
(208) 777-8580
Mailing address
PO BOX 3250, POST FALLS, ID 83877-3250
(208) 777-9199
(208) 777-8580

Taxonomy

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

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010014605
BLUE SHIELD OF ID
ID
05
001274700
ID
01
0144814
WA DEPT OF LABOR
WA
01
03566
BLUE CROSS OF IDAHO, GA,
ID
05
806797600
ID
05
9048430
WA
Enumeration date
08/15/2006
Last updated
09/16/2008
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