Organization
LACKSON LLC
Active
Other names
Maternal Instincts
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANIE B LACKEY (CO-OWNER)
(208) 234-1921
Entity
Organization
Contact information
Practice address
1023 YELLOWSTONE AVE, D-1, POCATELLO, ID 83201-4478
(208) 234-8566
Mailing address
1023 YELLOWSTONE AVE, D-1, POCATELLO, ID 83201-4478
(208) 234-8566
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807536100
—
ID
Enumeration date
03/09/2009
Last updated
03/09/2009
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