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General NPI Number Information
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NPI Number | 1144309253
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Entity Type | Organization
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Legal Business Name | HEMATOLOGY-ONCOLOGY ASSOCIATES OF EASTERN IDAHO, PLLC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 2008 LAUREL AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-5808
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Country | US
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Telephone | 651-414-0971
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Fax |
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Provider Business Mailing Address
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Address Line | 2008 LAUREL AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-5808
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Country | US
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Telephone | 651-414-0971
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN PATRICK MULVEY
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Credential | MD
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Telephone | 651-414-0971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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