Organization
MHP IDAHO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN L WALKER (CHIEF CLINICAL OFFICER)
(208) 305-6131
Entity
Organization
Contact information
Practice address
1534 IDAHO ST, LEWISTON, ID 83501-2573
(208) 305-6131
Mailing address
1534 IDAHO ST, LEWISTON, ID 83501-2573
(208) 305-6131
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
207R00000X
Internal Medicine Physician
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1386698322
NPI
ID
01
—
1861741159
NPI
ID
Enumeration date
02/03/2021
Last updated
05/19/2021
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