Healthcare Provider Details

I. General information

NPI: 1043262082
Provider Name (Legal Business Name): ONEIDA COUNTY HOSPITAL PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N 200 W
MALAD ID
83252-1239
US

IV. Provider business mailing address

150 N 200 W
MALAD ID
83252-1239
US

V. Phone/Fax

Practice location:
  • Phone: 208-766-2231
  • Fax: 208-766-4819
Mailing address:
  • Phone: 208-766-2231
  • Fax: 208-766-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number41
License Number StateID

VIII. Authorized Official

Name: TODD V WINDER
Title or Position: ADMINISTRATOR / CEO
Credential:
Phone: 208-766-2231