Healthcare Provider Details

I. General information

NPI: 1588666945
Provider Name (Legal Business Name): HEALTH WEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 N MAIN ST
DOWNEY ID
83234
US

IV. Provider business mailing address

PO BOX 2377
POCATELLO ID
83206-2377
US

V. Phone/Fax

Practice location:
  • Phone: 208-897-5600
  • Fax: 208-897-5603
Mailing address:
  • Phone: 208-232-7862
  • Fax: 208-232-7869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM7806
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MINDY BENEDETTI
Title or Position: CEO
Credential:
Phone: 208-232-7862