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Organization

ID DEPT OF HEALTH & WELFARE CSHP (HD2)

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PAIGE FINCHER BSW (ACTING PROGRAM MANAGER)
(208) 334-4935
Entity
Organization

Contact information

Practice address
215 10TH ST, LEWISTON, ID 83501-1910
(208) 799-0386
(208) 799-0349
Mailing address
PO BOX 83720, 4TH FLOOR, BOISE, ID 83720-0036
(208) 334-4935
(208) 332-7307

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010022948
BLUE SHIELD
ID
05
0028238
ID
01
HW207
BLUE CROSS OF ID
ID
Enumeration date
04/04/2007
Last updated
08/22/2020
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