Healthcare Provider Details

I. General information

NPI: 1467780429
Provider Name (Legal Business Name): LEWIS COUNTY IDAHO CORONER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 OAK ST ROOM 5
NEZPERCE ID
83543-5064
US

IV. Provider business mailing address

510 OAK ST ROOM 5
NEZPERCE ID
83543-5064
US

V. Phone/Fax

Practice location:
  • Phone: 208-937-2698
  • Fax: 208-937-9235
Mailing address:
  • Phone: 208-937-2698
  • Fax: 208-937-9235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number2131
License Number StateID

VIII. Authorized Official

Name: MR. C ROBERT PRATT
Title or Position: CORONER
Credential:
Phone: 208-937-2698