Healthcare Provider Details

I. General information

NPI: 1285794339
Provider Name (Legal Business Name): SOUTH CENTRAL PUBLIC HEALTH DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 WASHINGTON ST N
TWIN FALLS ID
83301-3156
US

IV. Provider business mailing address

1020 WASHINGTON ST N
TWIN FALLS ID
83301-3156
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-5900
  • Fax:
Mailing address:
  • Phone: 208-734-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1046
License Number StateID

VIII. Authorized Official

Name: MR. RENE LEBLANC
Title or Position: DISTRICT DIRECTOR
Credential:
Phone: 208-737-5902