Organization
POCATELLO PA SERVICE LLC
Active
Organization
POCATELLO PA SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN BOE SIMMONS PA-C (OWNER)
(208) 241-0876
Entity
Organization
Contact information
Practice address
333 N 18TH AVE STE D2, POCATELLO, ID 83201-3358
(208) 232-6490
Mailing address
2310 SATTERFIELD DR, POCATELLO, ID 83201-7905
(208) 241-0876
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
PA-272
ID
Other
Enumeration date
04/19/2012
Last updated
04/19/2012
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