Healthcare Provider Details

I. General information

NPI: 1043372048
Provider Name (Legal Business Name): SHAVER HOLDINGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 S 4TH
POCATELLO ID
83201
US

IV. Provider business mailing address

235 S 4TH AVE
POCATELLO ID
83201-6438
US

V. Phone/Fax

Practice location:
  • Phone: 208-232-7750
  • Fax: 208-233-3343
Mailing address:
  • Phone: 208-232-7750
  • Fax: 208-233-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberDME264
License Number StateID

VIII. Authorized Official

Name: DANIEL TORI SHAVER
Title or Position: OWNER
Credential:
Phone: 208-235-7243