Organization
PODIATRY SERVICES OF IDAHO, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAMILLE ELIZABETH HARRIS DPM (CEO)
(208) 402-6587
Entity
Organization
Contact information
Practice address
229 E LOGAN ST, CALDWELL, ID 83605-4835
(208) 402-6587
(084) 026-5782
Mailing address
1105 E USTICK RD, CALDWELL, ID 83605-6306
(208) 402-6587
(208) 402-6578
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DP00359
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023111
—
OR
01
—
4540570001
MEDICARE DMERC
OR
05
—
807150700
—
ID
01
—
DD5083
RAILROAD MEDICARE GROUP NUMBER
OR
01
—
P00251554
RAILROAD MEDICARE
OR
Enumeration date
07/03/2007
Last updated
03/01/2022
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