Organization
PHS AMBULATORY SERVICES LLC
Active
Parent organization
POCATELLO HEALTH SYSTEM, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
POCATELLO HEALTH SYSTEM, LLC
Authorized official
STEPHEN PETROVICH (EVP GENERAL COUNSEL)
(615) 296-3594
Entity
Organization
Contact information
Practice address
2850 OLYMPUS DR, POCATELLO, ID 83201-2271
(208) 239-2273
Mailing address
340 SEVEN SPRINGS WAY STE 100, BRENTWOOD, TN 37027-5697
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
07/10/2023
Last updated
10/03/2023
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