| NPI | 1619029824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN M NELSON Business Office Administrator 208-667-5483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: ID M3977) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: ID M3978) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2008-08-27 |