Organization
CRANIOFACIAL PAIN CENTER OF IDAHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE MARY MILNER (VP OF OPERATIONS)
(208) 376-3600
Entity
Organization
Contact information
Practice address
3400 LA TOUCHE ST., ANCHORAGE, AK 99508-4208
(208) 376-3600
(208) 376-3616
Mailing address
8119 W USTICK RD, BOISE, ID 83704-5754
(208) 376-3600
(208) 376-3616
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
01/16/2013
Last updated
08/31/2015
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