Organization
CEDAR MOUNTAIN MEDICAL INC.
Active
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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