Organization
PHS MD #2, LLC
Active
Parent organization
POCATELLO HEALTH SERVICES, LLC
Other names
PORTNEUF MEDICAL PRACTICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
POCATELLO HEALTH SERVICES, LLC
Authorized official
JOHN ABREU (CFO)
(208) 239-2110
Entity
Organization
Contact information
Practice address
651 MEMORIAL DR, POCATELLO, ID 83201-4071
(208) 239-2110
(208) 239-2145
Mailing address
PO BOX 4168, POCATELLO, ID 83205-4168
(208) 239-2110
(208) 239-2145
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
ID
Other
Enumeration date
11/17/2009
Last updated
03/02/2010
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