Organization
OBHG IDAHO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLIFF LAWRENCE (ASSISTANT SECRETARY)
(864) 908-3530
Entity
Organization
Contact information
Practice address
1717 ARLINGTON AVE, CALDWELL, ID 83605-4802
(864) 908-3530
Mailing address
777 LOWNDES HILL RD BLDG 1, GREENVILLE, SC 29607-2101
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
Other
Enumeration date
07/31/2020
Last updated
07/31/2020
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