Organization
FULL OF LIFE 5580
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLARD R PRICE (OWNER)
(208) 521-0155
Entity
Organization
Contact information
Practice address
697 E 1600 N, IDAHO FALLS, ID 83402-5752
(208) 521-0155
(208) 357-7516
Mailing address
697 E 1600 N, IDAHO FALLS, ID 83402-5752
(208) 521-0155
(208) 357-7516
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
003513710-S
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003513710-S
SELLER'S PERMIT
ID
Enumeration date
01/13/2010
Last updated
01/13/2010
About Stedi
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