| NPI | 1992070809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORI D ANDERSON Billing Manager 208-522-7246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: ID SPHY11061) |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2012-03-12 |