Organization
SOPERS MOBILITY AIDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GENEVA J SOPER (OWNER MANAGER)
(208) 772-6474
Entity
Organization
Contact information
Practice address
7392 N GOVERNMENT WAY, DALTON GARDENS, ID 83815-8762
(208) 772-6474
(208) 772-6797
Mailing address
PO BOX 2344, HAYDEN, ID 83835
(208) 772-6474
(208) 772-6797
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
59
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010137053
REGENCE BLUE SHIELD
ID
05
—
805503900
—
ID
05
—
805521400
—
ID
01
—
8F728
BLUE CROSS OF IDAHO
ID
05
—
9054511
—
WA
Enumeration date
03/09/2006
Last updated
02/23/2015
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