Organization
CARDIOVASCULAR SPECIALISTS OF AMERICA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE SPENCER LONGMORE DO (OWNER)
(208) 760-7707
Entity
Organization
Contact information
Practice address
1515 E CLARK ST, POCATELLO, ID 83201-4133
(000) 000-0000
Mailing address
1515 E CLARK ST, POCATELLO, ID 83201-4133
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
PENDING
—
Enumeration date
10/08/2020
Last updated
10/08/2020
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