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General NPI Number Information
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NPI Number | 1033148200
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Entity Type | Organization
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Legal Business Name | SOUTHERN IDAHO CARDIOLOGY ASSOCIATES, P.L.L.C.
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 414 SHOUP AVE W SUITE B
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City | TWIN FALLS
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State | ID
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Zip | 83301-5042
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Country | US
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Telephone | 208-734-4880
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Fax | 208-734-3959
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Provider Business Mailing Address
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Address Line | 414 SHOUP AVE W SUITE E
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City | TWIN FALLS
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State | ID
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Zip | 83301-5042
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Country | US
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Telephone | 208-734-4880
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Fax | 208-734-3959
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DAVID L KEMP
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Credential | M.D.
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Telephone | 208-734-4880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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