Organization
PORTNEUF ASC, LLC
Active
Parent organization
POCATELLO HEALTH SYSTEM, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
POCATELLO HEALTH SYSTEM, LLC
Authorized official
STEPHEN C PETROVICH (EVP)
(615) 296-3000
Entity
Organization
Contact information
Practice address
1151 HOSPITAL WAY BLDG A, POCATELLO, ID 83201-5091
(208) 232-6616
(208) 232-6618
Mailing address
1 BURTON HILLS BLVD STE 250, NASHVILLE, TN 37215-6195
(615) 296-3000
(615) 296-6227
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
07/19/2017
Last updated
07/19/2017
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