Organization
IDAHO STATE UNIVERSITY DEPARTMENT OF FAMILY MEDICINE
Active
Parent organization
HEALTH WEST INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
HEALTH WEST INC.
Authorized official
LAURIE POWELL (AUTHORIZATION SPECIALIST)
(208) 232-6260
Entity
Organization
Contact information
Practice address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 282-4141
Mailing address
1000 N 8TH AVE, POCATELLO, ID 83201-5757
(208) 232-6260
(208) 232-6259
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/24/2016
Last updated
05/24/2016
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