| NPI | 1871685321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LLOYD E WITHAM Physician 208-667-7459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: ID M5216) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: ID M5216) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2008-03-27 |