Organization
SUSAN M SANDRIDGE
Active
Other names
VISIONS
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN M SANDRIDGE BFA (OWNER)
(208) 233-4748
Entity
Organization
Contact information
Practice address
1255 E WHITMAN, POCATELLO, ID 83201-5748
(208) 233-4748
Mailing address
PO BOX 423, POCATELLO, ID 83204-0423
(208) 233-4748
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806009700
—
ID
05
—
806009800
—
ID
Enumeration date
05/05/2007
Last updated
07/23/2008
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