Organization
SNAKE RIVER PEDIATRICS, PC
Active
Organization
SNAKE RIVER PEDIATRICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW JOSEPH BERRIA PHD, PA-C (PRESIDENT)
(208) 740-4518
Entity
Organization
Contact information
Practice address
1100 NW 12TH ST, FRUITLAND, ID 83619-5040
(208) 452-6556
(541) 216-6557
Mailing address
1100 NW 12TH ST, FRUITLAND, ID 83619-5040
(208) 452-6556
(541) 216-6557
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
PA000913
OR
261QR1300X
Rural Health Clinic/Center
Primary
PA000913
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902985740
NPI
—
05
—
500605243
—
OR
Enumeration date
07/08/2015
Last updated
08/16/2023
Update your record
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