Healthcare Provider Details

I. General information

NPI: 1861547390
Provider Name (Legal Business Name): NEUROLOGY OF TWIN FALLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 ADDISON AVE W SUITE 200
TWIN FALLS ID
83301-5491
US

IV. Provider business mailing address

PO BOX 2790
TWIN FALLS ID
83303-2790
US

V. Phone/Fax

Practice location:
  • Phone: 208-737-2530
  • Fax: 208-737-2731
Mailing address:
  • Phone: 208-737-2530
  • Fax: 208-737-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD J HAMMOND
Title or Position: OWNER
Credential: M.D.
Phone: 208-737-2530