| NPI | 1538225545 |
|---|---|
| Doing Business As | STATE HOSPITAL SOUTH MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | LYNN D SHIELDS Patient Accounts Specialist 208-785-8462 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X (Licence: ID 17) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2016-07-15 |