Healthcare Provider Details

I. General information

NPI: 1154514669
Provider Name (Legal Business Name): BANDZ, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WEST MAIN ST.
SMELTERVILLE ID
83868-0219
US

IV. Provider business mailing address

PO BOX 219 1000 WEST MAIN ST
SMELTERVILLE ID
83868-0219
US

V. Phone/Fax

Practice location:
  • Phone: 208-784-1178
  • Fax: 208-786-2911
Mailing address:
  • Phone: 208-784-1178
  • Fax: 208-786-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES CLIFTON MARSHALL III
Title or Position: PRESIDENT
Credential:
Phone: 208-784-1178