Organization
IDAHO DEPT OF HEALTH & WELFARE ITP REGION 5
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY J JONES B.U.S. (PROGRAM MANAGER)
(208) 334-5523
Entity
Organization
Contact information
Practice address
803 HARRISON ST, TWIN FALLS, ID 83301-3925
(208) 736-2182
(208) 736-2135
Mailing address
PO BOX 5579, TWIN FALLS, ID 83303-5579
(208) 736-2182
(208) 736-2135
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010025423
BLUE SHIELD
ID
05
—
0028405
—
ID
01
—
HW132
BLUE CROSS OF IDAHO
ID
Enumeration date
02/09/2007
Last updated
08/05/2013
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