Organization
EDWARD H NEWCOMBE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARMEN VALORY CARLO (OFFICE/BILLING MANAGER)
(208) 375-0722
Entity
Organization
Contact information
Practice address
2036 N COLE RD, BOISE, ID 83704-7309
(208) 375-0722
Mailing address
2036 N COLE RD, BOISE, ID 83704-7309
(208) 375-0722
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
M2849
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001117802
—
ID
Enumeration date
01/22/2007
Last updated
03/05/2009
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