| NPI | 1073376695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD JOSEPH KENT Owner 208-500-8667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2024-02-22 |