Healthcare Provider Details

I. General information

NPI: 1316185903
Provider Name (Legal Business Name): EASTERN IDAHO HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CHANNING WAY
IDAHO FALLS ID
83404
US

IV. Provider business mailing address

820 EVERGREEN AVE
PITTSBURGH PA
15209-2257
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-6111
  • Fax:
Mailing address:
  • Phone: 800-655-2656
  • Fax: 412-822-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUG CRABTREE
Title or Position: CEO
Credential:
Phone: 202-529-6111