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General NPI Number Information
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NPI Number | 1093245953
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Entity Type | Organization
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Legal Business Name | EMP IDAHO NAMPA, LLC
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 1510 12TH AVENUE RD SUITE 100
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City | NAMPA
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State | ID
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Zip | 83686
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Country | US
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Telephone | 713-637-1146
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Fax | 281-298-5311
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Provider Business Mailing Address
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Address Line | 8686 NEW TRAILS DR STE 100
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City | THE WOODLANDS
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State | TX
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Zip | 77381-1176
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Country | US
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Telephone | 713-637-1146
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Fax | 281-298-5311
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Authorized Official
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Title or Position | SECRETARY
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Name | JOHN BUCK
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Credential | MD
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Telephone | 713-637-1004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 71
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License Number State | ID
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