Organization Name: | MOUNTAIN HEALTH MID LEVEL |
NPI Number: | 1700076510 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LYNN HAUGHN (OFFICE MANAGER) |
Mailing Address: | 740 Mckinley Ave Kellogg |
State: | ID US |
Postal Code: | 838372693 |
Phone Number: | 2087831267 |
Fax Number: | 2087864471 |
NPI Enumeration Date: | 07/27/2007 |
NPI Last Update Date: | 08/15/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA301 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ID |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |