| Organization Name: | SOUTHEASTERN DISTRICT HEALTH DEPARTMENT |
| NPI Number: | 1023250966 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIM L. BARRERA (MEDICA RECORDS EXAMINER) |
| Mailing Address: | 1901 Alvin Ricken Dr Pocatello |
| State: | ID US |
| Postal Code: | 832012727 |
| Phone Number: | 2082339080 |
| Fax Number: | 2082347169 |
| NPI Enumeration Date: | 03/24/2009 |
| NPI Last Update Date: | 03/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |