Idaho Dept Of Health & Welfare Reg 6 Amh Clinic Poc

LBN: Idaho Dept Of Health & Welfare Reg 6 Amh Clinic Poc
Idaho Dept Of Health & Welfare Reg 6 Amh Clinic Poc is an health care organization with primary practice located at 421 Memorial Dr , Pocatello ID 83201-4008. The organization recently has only one registered license in Ambulatory Health Care Facilities / Adult Mental Health, which is considered as the primary health care specialty. Idaho Dept Of Health & Welfare Reg 6 Amh Clinic Poc can be contacted via phone (208) 234-7900, or through Axford, Ed via phone (208) 234-7900.

Contact Information

Primary practice address
421 Memorial Dr Pocatello ID 83201-4008
Fax: (208) 236-6328
Website:
Authorized official contact:
Name: Axford, Ed

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Adult Mental Health 261QM0850X

Profile Details

NPI number 1811028889
LBN Legal business name Idaho Dept Of Health & Welfare Reg 6 Amh Clinic Poc
DBA Doing business as
Authorized official Axford, Ed
Entity Organization
Organization subpart 1 No
Enumeration date Mar 8th, 2007
Last updated Aug 22nd, 2020 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811028889 NPPES
Idaho Other 000010019235 BLUE SHIELD
Idaho Other HW108 BLUE SHIELD
Idaho MEDICAID 0028475 BLUE SHIELD

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