Organization
IDAHO DEPT OF HEALTH & WELFARE ITP REGION 5
Active
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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