Organization
STATE OF IDAHO
Active
Organization
STATE OF IDAHO
Active
Other names
State Hospital South Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
RALPH DUANE HECKARD M.D. (MEDICAL DIRECTOR)
(208) 785-8429
Entity
Organization
Contact information
Practice address
700 EAST ALICE, BLACKFOOT, ID 83221
(208) 785-8429
(208) 785-8439
Mailing address
BOX 400, 700 EAST ALICE, BLACKFOOT, ID 83221
(208) 785-8429
(208) 785-8439
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
ID
Other
Enumeration date
12/28/2006
Last updated
08/22/2020
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