Organization Name: | JOSEPH R. PETERSEN, M.D. |
NPI Number: | 1154744407 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSEPH R PETERSEN (MD/OWNER) |
Mailing Address: | 1344 Hiland Ave Suite A Burley |
State: | ID US |
Postal Code: | 833181564 |
Phone Number: | 2086781138 |
Fax Number: | 2086785833 |
NPI Enumeration Date: | 01/22/2014 |
NPI Last Update Date: | 01/22/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | ========= |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |