Organization
HEALTH WEST
Active
Parent organization
ISU RESDENCY
Organization subpart
Yes
Provider details
NPI number
Legal business name
ISU RESDENCY
Authorized official
JEREMY SMUIN (INFORMATION SPECIALIST)
(208) 232-7862
Entity
Organization
Contact information
Practice address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 234-4700
Mailing address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 234-4700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MRM-1500
ID
Other
Enumeration date
07/10/2015
Last updated
08/14/2015
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