STATE OF IDAHO

Public Health or Welfare

Active Organization
NPI: 1063576445

Practice Address

1901 ALVIN RICKEN DR
Pocatello, ID 83201

Phone: (208) 233-9080

Specialties

Specialty Code Primary License
Public Health or Welfare 251K00000X Yes -

Frequently Asked Questions

NPI 1063576445 is the National Provider Identifier for STATE OF IDAHO, a Public Health or Welfare provider located in Pocatello, ID. This NPI was enumerated on December 20, 2006.

Quick Facts

NPI
1063576445
Type
Organization
Enumerated
Dec 20, 2006
Last Updated
Jun 30, 2008

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