Healthcare Provider Details

I. General information

NPI: 1558407650
Provider Name (Legal Business Name): COUNTY OF TWIN FALLS CLASS A SCH DIST 412
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MAIN ST
BUHL ID
83316-1238
US

IV. Provider business mailing address

104 E FAIRVIEW AVE STE 201
MERIDIAN ID
83642-1733
US

V. Phone/Fax

Practice location:
  • Phone: 208-543-9208
  • Fax: 208-543-5185
Mailing address:
  • Phone: 208-922-3093
  • Fax: 208-922-9351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateID

VIII. Authorized Official

Name: MR. TODD KENNETH LEVESQUE
Title or Position: SYSTEMS MANAGER
Credential:
Phone: 208-922-3093