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General NPI Number Information
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NPI Number | 1104861368
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Entity Type | Individual
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Provider Name | STEPHEN L. RICHINS PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 711 RIGBY LAKE DR STE. 114
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City | RIGBY
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State | ID
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Zip | 83442-5229
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Country | US
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Telephone | 208-234-1300
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Fax | 208-234-1333
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Provider Business Mailing Address
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Address Line | 1448 E CENTER ST SUITE E
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City | POCATELLO
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State | ID
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Zip | 83201-4105
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Country | US
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Telephone | 208-234-1300
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Fax | 208-234-1333
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-931
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License Number State | ID
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