Organization
PHG INC.
Active
Other names
Maag Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
TROY PAZ (PRESIDENT)
(208) 233-2063
Entity
Organization
Contact information
Practice address
61 E 1ST S, SODA SPRINGS, ID 83276-1437
(208) 547-2697
Mailing address
PO BOX 505, POCATELLO, ID 83204-0505
(208) 233-2063
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
DME141
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
73779
BLUE SHIELD OF IDAHO
ID
01
—
8F546
BLUE CROSS OF IDAHO
ID
Enumeration date
02/06/2007
Last updated
08/22/2020
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