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General NPI Number Information
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NPI Number | 1114731882
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Entity Type | Organization
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Legal Business Name | EAGLE HEALTH SERVICES LLC
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1351 W PINE AVE STE B
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City | MERIDIAN
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State | ID
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Zip | 83642-2010
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Country | US
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Telephone | 385-420-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 FLINT MEADOW DR STE 1C
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City | KAYSVILLE
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State | UT
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Zip | 84037-6833
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | TANGINA MALOOF
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Credential |
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Telephone | 469-636-5055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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