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General NPI Number Information
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NPI Number | 1154426104
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Entity Type | Organization
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Legal Business Name | EASTERN IDAHO PUBLIC HEALTH DISTRICT
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 1250 HOLLIPARK DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-6217
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Country | US
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Telephone | 208-522-0310
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Fax | 208-525-7063
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Provider Business Mailing Address
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Address Line | 1250 HOLLIPARK DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-6217
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Country | US
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Telephone | 208-522-0310
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Fax | 208-525-7063
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. WILLIAM J CORBETT
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Credential |
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Telephone | 208-522-0310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | N/A
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License Number State | ID
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