Healthcare Provider Details

I. General information

NPI: 1487858023
Provider Name (Legal Business Name): SAINT ALPHONSUS PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W IOWA AVE
NAMPA ID
83686-2834
US

IV. Provider business mailing address

315 EAST ELM STREET SUITE 20
CALDWELL ID
83605-4881
US

V. Phone/Fax

Practice location:
  • Phone: 208-465-7377
  • Fax: 208-465-7397
Mailing address:
  • Phone: 208-453-3383
  • Fax: 208-453-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA L. BRAHE
Title or Position: COO
Credential:
Phone: 208-367-7939