Healthcare Provider Details

I. General information

NPI: 1497975320
Provider Name (Legal Business Name): BATTELLE ENERGY ALLIANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 FREMONT AVE
IDAHO FALLS ID
83402-1510
US

IV. Provider business mailing address

1955 FREMONT AVE
IDAHO FALLS ID
83402-1510
US

V. Phone/Fax

Practice location:
  • Phone: 208-526-0404
  • Fax:
Mailing address:
  • Phone: 208-526-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateID

VIII. Authorized Official

Name: PAUL W. JOHNS
Title or Position: SITE OCCUPATIONAL MEDICINE DIRECTOR
Credential: M.D.
Phone: 208-526-0404