Healthcare Provider Details

I. General information

NPI: 1699942383
Provider Name (Legal Business Name): PATIENTS FIRST NEUROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 CHANNING WAY STE 100
IDAHO FALLS ID
83404-7531
US

IV. Provider business mailing address

2860 CHANNING WAY STE 100
IDAHO FALLS ID
83404-7531
US

V. Phone/Fax

Practice location:
  • Phone: 208-535-4585
  • Fax: 208-535-4569
Mailing address:
  • Phone: 208-535-4585
  • Fax: 208-535-4569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID J. KANE
Title or Position: VP
Credential:
Phone: 801-568-5999