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Organization

JUMP START PEDIATRICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BECCA FAHEY (OFFICE MANAGER)
(208) 664-2468
Entity
Organization

Contact information

Practice address
411 W HAYCRAFT AVE STE D4, COEUR D ALENE, ID 83815-8104
(206) 664-2468
Mailing address
411 W HAYCRAFT AVE STE D4, COEUR D ALENE, ID 83815-8104

Taxonomy

Speciality
Code
Description
License number
State
251X00000X
Supports Brokerage Agency
Primary
OT-1455
ID

Other

Enumeration date
05/11/2015
Last updated
05/11/2015
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