Healthcare Provider Details

I. General information

NPI: 1588724512
Provider Name (Legal Business Name): IDAHO EM-I MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 12TH AVE RD
NAMPA ID
83686-6008
US

IV. Provider business mailing address

3916 STATE ST SUITE 300
SANTA BARBARA CA
93105-5602
US

V. Phone/Fax

Practice location:
  • Phone: 208-463-5100
  • Fax:
Mailing address:
  • Phone: 805-563-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK JEFFREY SLEPIN
Title or Position: PRESIDENT
Credential: MD
Phone: 805-563-3011