| NPI | 1942836911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN HATCH CEO 208-538-3122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 103T00000X Psychologist |
| 104100000X Social Worker | |
| 106H00000X Marriage & Family Therapist | |
| 111N00000X Chiropractor | |
| 207LP2900X Anesthesiology, Pain Medicine | |
| 207Q00000X Family Medicine | |
| 208VP0000X Pain Medicine, Pain Medicine | |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| 291U00000X Clinical Medical Laboratory | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2023-09-19 |